EOB XWALK FOR WEB -
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CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB ADJUSTMENT REASON CODE MEDICAID EOB EOB MESSAGE TEXT A1 1 PROVIDER TYPE INCONSISTENT WITH CLAIM TYPE. 26 2 BENEFICIARY INELIGIBLE FOR DATES OF SERVICE 97 3 PAYMENT FOR SERVICE IS INCLUDED IN ENCOUNTER RATE 59 4 PAYMENT REDUCED TO MAX.ALLOWED/MULT.SURGERY RULES; LESSER PROCEDURE ALREADY PAID 169 5 YOUR CLAIM WAS GIVEN INDIVIDUAL CONSIDERATION AND REIMBURSED ACCORDINGLY. B7 6 PROVIDER NUMBER HAS NOT BEEN RENEWED. CONTACT DXC ENROLLMENT FOR ASSISTANCE. 128 7 NEWBORN CARE BILLABLE UNDER MOTHER'S ID FOR 7 DAYS 31 8 BENEFICIARY NUMBER NOT ON FILE. 140 9 BENEFICIARY NAME/NUMBER DOES NOT MATCH OUR FILES B13 10 CLAIM DENIED. PAYMENT HAS ALREADY BEEN MADE ON YOUR ELECTRONIC CLAIM SUBMISSION. B7 11 PROVIDER NAME AND NUMBER MUST MATCH THE NAME THAT IS ON THE ENROLLMENT FORM. 206 12 REFERRING PHYSICIAN NUMBER IS INVALID 16 13 INDIVIDUAL CHARGES DO NOT EQUAL THE SUM OF THE DETAILS 16 14 OTHER INSURANCE INDICATOR MISSING/INVALID. CORRECT TO 1-YES OR 2-NO AND RESUBMIT 143 15 ALLOWED AMOUNT REDUCED BY SPENDDOWN. B11 16 VERIFICATION OF COVERAGE INDICATES POLICY IN EFFECT FOR ALL/PORTION OF DAYS. 16 17 NET CHARGE MISSING. 16 18 REFERRING PHYSICIAN NUMBER REQUIRED AND NOT PRESENT. 251 19 RECIPIENT MEDICAID ID NUMBER MISSING ON AMBULANCE ATTACHMENT. 50 20 CLAIM DENIED. DOES NOT WARRANT AMBULANCE USE. 16 21 REFERRING PHYSICIAN CANNOT BE SAME AS ATTENDING PHYSICIAN 146 22 PRIMARY DIAGNOSIS MISSING OR INVALID 16 23 OUTPT LAB (REV.CDE.300 OR 310) REQUIRES A LAB HCPCS CODE FROM 80002-89399 SERIES 16 24 REFERRING PHYSICIAN NUMBER NOT ON FILE. 16 25 ATTENDING PHYSICIAN NUMBER REQUIRED AND IT IS NOT PRESENT, OR IT IS NOT ON FILE 16 26 SURGICAL DATE IS MISSING OR INVALID 119 27 ZYBAN SMOKING CESSATION PROGRAM LIMIT OF ONE 90/DAY SUPPLY PER 365 DAYS EXCEEDED 23 28 NO PAYMENT IS DUE BECAUSE OTHER INSURANCE HAS PAID MORE THAN DVHA ALLOWED AMOUNT 16 29 SURGICAL PROCEDURE DATE IS MISSING B7 30 PROVIDER INACTIVE ON OR DURING DATES OF SERVICE.
Transcript of EOB XWALK FOR WEB -
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
A1 1 PROVIDER TYPE INCONSISTENT WITH CLAIM TYPE.
26 2 BENEFICIARY INELIGIBLE FOR DATES OF SERVICE
97 3 PAYMENT FOR SERVICE IS INCLUDED IN ENCOUNTER RATE
59 4 PAYMENT REDUCED TO MAX.ALLOWED/MULT.SURGERY RULES; LESSER PROCEDURE ALREADY PAID
169 5 YOUR CLAIM WAS GIVEN INDIVIDUAL CONSIDERATION AND REIMBURSED ACCORDINGLY.
B7 6 PROVIDER NUMBER HAS NOT BEEN RENEWED. CONTACT DXC ENROLLMENT FOR ASSISTANCE.
128 7 NEWBORN CARE BILLABLE UNDER MOTHER'S ID FOR 7 DAYS
31 8 BENEFICIARY NUMBER NOT ON FILE.
140 9 BENEFICIARY NAME/NUMBER DOES NOT MATCH OUR FILES
B13 10 CLAIM DENIED. PAYMENT HAS ALREADY BEEN MADE ON YOUR ELECTRONIC CLAIM SUBMISSION.
B7 11 PROVIDER NAME AND NUMBER MUST MATCH THE NAME THAT IS ON THE ENROLLMENT FORM.
206 12 REFERRING PHYSICIAN NUMBER IS INVALID
16 13 INDIVIDUAL CHARGES DO NOT EQUAL THE SUM OF THE DETAILS
16 14 OTHER INSURANCE INDICATOR MISSING/INVALID. CORRECT TO 1-YES OR 2-NO AND RESUBMIT
143 15 ALLOWED AMOUNT REDUCED BY SPENDDOWN.
B11 16 VERIFICATION OF COVERAGE INDICATES POLICY IN EFFECT FOR ALL/PORTION OF DAYS.
16 17 NET CHARGE MISSING.
16 18 REFERRING PHYSICIAN NUMBER REQUIRED AND NOT PRESENT.
251 19 RECIPIENT MEDICAID ID NUMBER MISSING ON AMBULANCE ATTACHMENT.
50 20 CLAIM DENIED. DOES NOT WARRANT AMBULANCE USE.
16 21 REFERRING PHYSICIAN CANNOT BE SAME AS ATTENDING PHYSICIAN
146 22 PRIMARY DIAGNOSIS MISSING OR INVALID
16 23 OUTPT LAB (REV.CDE.300 OR 310) REQUIRES A LAB HCPCS CODE FROM 80002-89399 SERIES
16 24 REFERRING PHYSICIAN NUMBER NOT ON FILE.
16 25 ATTENDING PHYSICIAN NUMBER REQUIRED AND IT IS NOT PRESENT, OR IT IS NOT ON FILE
16 26 SURGICAL DATE IS MISSING OR INVALID
119 27 ZYBAN SMOKING CESSATION PROGRAM LIMIT OF ONE 90/DAY SUPPLY PER 365 DAYS EXCEEDED
23 28 NO PAYMENT IS DUE BECAUSE OTHER INSURANCE HAS PAID MORE THAN DVHA ALLOWED AMOUNT
16 29 SURGICAL PROCEDURE DATE IS MISSING
B7 30 PROVIDER INACTIVE ON OR DURING DATES OF SERVICE.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 31 PLEASE RESUBMIT ON APPROPRIATE CLAIM FORM
A1 32 TYPE OF BILL IS INVALID FOR THE SERVICES BILLED.
97 33 PAYMENT OF THIS DETAIL CONSIDERED ON FIRST LINE WITH THIS DATE OF SERVICE BILLED
16 34 ADMISSION DATE IS MISSING OR INVALID
16 35 THE ADMISSION DATE IS LATER THAN THE FROM AND/OR THRU DATE OF SERVICE.
16 36 INAPPROPRIATE CODE. REFER TO THE VT MEDICAID DENTAL FEE SCHEDULE
50 37 ADMISSION CODE DOES NOT WARRANT EMERGENCY ROOM/ SERVICES/SITUATION.
29 38 CLAIM PAST TIMELY FILING LIMIT-SUBMIT A TIMELY FILING APPEAL
119 39 DIABETIC COUNSELING G0108 IS LIMITED TO 12 SESSIONS PER CALENDAR YEAR
16 40 THE INFORMATION ON THE ATTACHMENT IS NOT VALID.
16 41 FROM DATE OF SERVICE IS MISSING OR INVALID.
16 42 PATIENT STATUS CODE IS MISSING OR INVALID
16 43 ADMISSION CODE OR POA INDICATOR IS MISSING OR INVALID
16 44 FROM DATE OF SERVICE IS INVALID.
16 45 THE DISCHARGE DATE OF SERVICE IS MISSING/INVALID
16 46 THE THRU DATE OF SERVICE IS MISSING OR INVALID
16 47 NDC IS MISSING, PLEASE SUBMIT A CORRECTED FORM.
16 48 INAPPROPRIATE PROCEDURE CODE. PLEASE REFER TO YOUR CURRENT CPT MANUAL
119 49 OADAP RESIDENTIAL INTENSIVE TREATMENT LIMITED TO 30 DAYS PER CALENDAR YEAR
16 50 INAPPROPRIATE BILLING OF MULTIPLE PROCEDURE OR HCPCS OR REVENUE CODES.
4 51 CODE/SERVICE OR CODE/MODIFIER COMBINATION NOT VALID FOR DATE OF SERVICE BILLED
31 52 THIS SERVICE IS NOT COVERED FOR NON-MEDICAID BENEFICIARIES
16 53 DATE OF SERVICE REQUIRED FOR EACH LINE BILLED.
16 54 THIS CODE HAS BEEN DELETED BY HCPCS. REFER TO MEDICARE UPDATES.
16 55 THE THRU DATE OF SERVICE IS BEFORE THE FROM DATE OF SERVICE.
16 56 DOCUMENTATION NEEDED SUBSTANTIATING NUMBER OF UNITS BILLED.
16 57 BILL CODE ONCE ONLY WITH TOTAL NUMBER OF UNITS. INCLUDE OP NOTES AND/OR EXPLAIN.
16 58 QUANTITY OR UNITS MISSING
16 59 NOTICE OF DECISION ATTACHMENT MISSING
16 60 DETAIL CHARGE IS MISSING
45 61 NO PAYMENT DUE. SPENDDOWN GREATER OR EQUAL TO ALLOWED AMOUNT.
16 62 INCORRECT BILLING OF SPENDDOWN ACCORDING TO INSTRUCTIONS
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
197 63 THIS SERVICE REQUIRES PRIOR AUTHORIZATION
16 64 REVENUE CODE DOES NOT MATCH DESCRIPTION PROVIDED. PLEASE CORRECT AND RESUBMIT.
16 65 THE PLACE OF SERVICE CODE IS MISSING
96 66 SERVICE OVERLAPS GENERAL ASSISTANCE AND MEDICAID PROGRAMS. DXC WILL RESUBMIT
16 67 PROCEDURE CODE MISSING
16 68 NDC NOT ON FILE
16 69 NDC/PROCEDURE DOES NOT MATCH DESCRIPTION PROVIDED. PLEASE CORRECT AND RESUBMIT.
204 70 NON-COVERED SERVICE FOR PROVIDER AS BENEFICIARY NOT IN PCP PROGRAM.
16 71 PRESCRIBING PHYSICIAN NUMBER MISSING
16 72 DISPENSING DATE MISSING/INVALID.
16 73 ESTIMATED DAYS SUPPLY MISSING
97 74 SERVICE INCLUDED IN OFFICE/MEDICAL VISIT.
45 75 ADA MEMBERSHIP FEE (PROCEDURE CODE W8001) LTD.TO ONCE PER RECIPIENT LIFETIME.
119 76 CLAIM/DETAIL DENIED. DME PURCHASE HAS BEEN REACHED.
16 77 REFILL INDICATOR IS MISSING OR INVALID
143 78 ADJUSTMENT RESULTED IN REDUCED PAYMENT. ACCOUNTS RECEIVABLE SET UP FOR RESIDUAL
16 79 VT MEDICAID HAS A UNIQUE PROCEDURE CODE FOR THIS SERVICE.
16 80 MEDICAL NECESSITY FORM INCOMPLETE. PLEASE COMPLETE AND RESUBMIT.
16 81 SIGNATURE ON MNF NOT WITHIN 6 MONTHS (ONE YR FOR OSTOMY/UROLOGIC) OF BILLED DOS
150 82 THIS PAYMENT IS THE RESULT OF AN ADJUSTMENT REQUEST
150 83 THIS RECOUPMENT IS THE RESULT OF AN ADJUSTMENT REQUEST.
88 84 THIS AMOUNT WITHHELD AS A RESULT OF AN OUTSTANDING RECEIVABLE
150 85 THIS CREDIT TRANSACTION IS THE RESULT OF YOUR REFUND REQUEST.
97 86 DETAIL DENIED: CONSIDERED INCLUDED IN A PREVIOUSLY BILLED SERVICE
150 87 THIS CREDIT TRANSACTION IS THE RESULT OF AN DXC CHECK ISSUED TO YOU IN ERROR.
97 88 ANOTHER PAID SERVICE/CODE IS INCLUDED IN THIS ONE. RECOUP IT BEFORE REBILLING.
16 89 BRAND CERTIFICATION INDICATOR MISSING
96 90 CLAIM/DETAIL DENIED. NO PAYMENT DUE WHEN RECIPIENT PAYS CHARGE.
109 91 SERVICE DENIED; NOT COVERED BY VERMONT MEDICAID PROGRAM
3 92 PAYMENT REDUCED DUE TO PRENATAL AND CHILDREN'S HEALTH CARE PROGRAM CO-PAY.
45 93 PAYMENT REDUCED TO MAXIMUM ALLOWABLE AMOUNT.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
97 94 A PORTION OR ALL OF THESE DAYS WERE PAID AS AN INPATIENT CLAIM.
23 95 CLAIM CUTBACK DUE TO OTHER INSURANCE PAYMENT
18 96 CLAIM DENIED. EXACT DUPLICATE OF SERVICE PREVIOUSLY PAID.
97 97 REIMBURSEMENT FOR ANCILLARY CHARGES INCLUDED IN PER DIEM RATE
88 98 THIS AMOUNT HAS BEEN APPLIED TO AN OUTSTANDING ACCOUNTS RECEIVABLE.
142 99 PAYMENT REDUCED BY APPLIED INCOME/PATIENT SHARE AMOUNT
16 100 YOUR RESUBMITTED CLAIM'S RA DATE IS ILLEGIBLE.
16 101 PROVIDER NAME MISSING.
16 102 CLAIM IS ILLEGIBLE. PLEASE RESUBMIT A LEGIBLE FORM.
16 103 CLAIM (DETAIL) DENIED. ATTACHMENT DOES NOT MATCH THE CLAIM
23 104 CLAIM DENIED. NO COINSURANCE OR DEDUCTIBLE DUE.
16 105 INITIAL EOB IS NEEDED IN ADDITION TO THE ADJUSMENT EOB TO PROCESS CLAIM.
204 106 SERVICE NOT COVERED FOR VHAP BENEFICIARY
16 107 CLAIM/DETAIL SUBMITTED WITHOUT ANY SERVICES BILLED.
16 108 REVENUE CODE IS MISSING OR INVALID
128 109 NEWBORN CARE BILLABLE UNDER MOTHER'S ID UNTIL MOTHER IS DISCHARGED
16 110 MEDICARE BENEFITS SHEET ILLEGIBLE. PLEASE RESUBMIT WITH LEGIBLE COPY
16 111 DEDUCTIBLE NON-COVERED. RECIPIENT IS INELIGIBLE ON THE FIRST DATE OF SERVICE.
B7 112 OUR RECORDS SHOW ATTENDING PHYSICIAN INELIGIBLE ON OR DURING DATE(S) OF SERVICE.
16 113 MEDICARE BENEFITS SHEET DOES NOT MATCH CLAIM
16 114 ATTENDING PROVIDER NUMBER IS INVALID.
16 115 MEDICARE PAID DATE MISSING OR ILLEGIBLE.
45 116 NO CROSS-OVER PAYMENT DUE. OTHER PAYMENT GREATER OR EQUAL TO ALLOWED AMOUNT.
16 117 ATTENDING/PRESCRIBING PROVIDER NUMBER NOT ON FILE.
16 118 THIS SURGICAL PROCEDURE CODE IS NOT A VALID ICD-PCS PROCEDURE CODE.
199 119 EXPLAIN USE OF ICD-9 PROCEDURE CODES 87-9999 WITH SURGERY-RELATED REVENUE CODE
16 120 PSRO INDICATOR MUST BE A C1 OR C5
252 121 REQUESTED PRIOR AUTHORIZATION HAS BEEN DENIED. NOTE STATUS ON RETURNED PA FORM.
198 122 THIS PRIOR AUTHORIZATION HAS ALREADY BEEN EXHAUSTED
16 123 ACCIDENT/OCCURENCE/EMPLOYMENT INDICATOR MISSING.
B12 124 ELECTRONIC ADJUSTMENT CAN NOT BE PROCESSED AT THIS TIME. PLEASE RESUBMIT AFTER 8/23/04.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 125 ACCIDENT/OCCURENCE DATE MISSING
197 126 PRIOR AUTHORIZATION FROM VDOH IS REQUIRED FOR MORE THAN 20 "AT RISK" VISITS/YEAR
16 127 YOUR RESUBMITTED CLAIM'S RA DATE IS MISSING.
16 128 COMPOUND DRUG ATTACHMENT IS ILLEGIBLE. RESUBMIT CLAIM WITH LEGIBLE ATTACHMENT.
15 129 THIS PROCEDURE CODE/SERVICE DOES NOT MATCH THE PROCEDURE CODE/SERVICE AUTHORIZED
97 130 CAST REMOVAL CODES CAN BE BILLED ONLY FOR CASTS APPLIED BY ANOTHER MD/MD GROUP
97 131 DETAIL DENIED. CAST APPLICATION INCLUDED IN INITIAL CARE.
16 132 DRUG PREGNANCY INDICATOR INVALID
5 133 PHYSICIAN CANNOT BILL CAST MATERIALS IN A NON-OFFICE SETTING.
24 134 SERVICES PRIOR TO JULY 1 WERE REIMBURSED BY CAPITATION PAYMENT.
45 135 PAYMENT DENIED: LOADING FEE CAP HAS BEEN REACHED.
A1 136 PHYSICIAN'S AUTHORIZATION MUST BE WITHIN 6 MONTHS OF DATE OF SERVICE.
15 137 THE CERTIFICATE NUMBER ON THE ATTACHMENT DOES NOT MATCH THE ONE ON OUR FILE.
16 138 RECIPIENT NAME, DOS, PROVIDER SIGNATURE AND CHARGES REQUIRED ON ATTACHMENT.
16 139 AMOUNT OF SPENDDOWN SHOULD BE ENTERED IN PRIOR PAYMENT FIELD ON UB92 CLAIMS
16 140 ONLY REVENUE CODES 300 OR 310 ARE ALLOWED ON OUTPATIENT CLAIMS WHEN BILLING LAB.
16 141 THESE SERVICES REQUIRE HCPCS/CPT CODES
16 142 INVALID REVENUE CODE FOR SERVICES RENDERED. REFER TO YOUR LIST OF CODES.
97 143 REIMBURSEMENT FOR ANCILLARY CHARGES INCLUDED IN %/PER DIEM RATE FOR BIRTH ROOM
119 144 TIME/UNITS EXCEED(S) THE NORM.PLEASE RESUBMIT WITH EXPLANATION OR DOCUMENTATION
16 145 NON-INJECTED MEDS ADMINISTERED IN THE OFFICE REQUIRE OFFICE NOTES AND INVOICE
3 146 CLAIM PAYMENT AMOUNT REDUCED BY REQUIRED CO-PAY.
197 147 PAYMENT DENIED: REQUIRED AUTHORIZATION WAS NOT OBTAINED IN ADVANCE OF SERVICE.
16 148 PROFESSIONAL REVIEW ORGANIZATION (PRO) CERTIFICATION FORM IS INCOMPLETE.
24 149 THIS IS THE PMPM PAYMENT FOR YOUR PARTICIPATION IN VERMONT PRIMARY CARE PLUS
16 150 EFFECTIVE DATE IS MISSING.
251 151 INFORMATION PROVIDED IN THE REQUIRED FIELD OR FIELDS ON THE CONSENT FORM IS INCORRECT
133 152 THIS ABORTION-RELATED SERVICE HAS BEEN FORWARDED TO ADMIN SERVICES FOR PAYMENT
16 153 REBILL ABORTION RELATED SERVICES SEPARATELY.
16 154 ABORTION CERTIFICATION FORM REQUIRED FOR PAYMENT
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
50 155 NON-URGENT SERVICE. RECIPIENT SHOULD BE REFERRED TO IN-STATE FACILITY.
16 156 EFFECTIVE DATE IS INVALID.
97 157 OBSERVATION ROOM SVCS PAID AT PER/DIEM OR PERCENTAGE RATES INCLUDE ANCILLARIES
45 158 APROVAL IS FOR INPATIENT. PAYMENT REDUCED TO PER DIEM RATE.
16 159 CPT CODE ALLOWED ONLY IN FIELD 81A & ONLY WHEN ICD-9 SURGICAL CODE IN FIELD 80
16 160 THIS MANUFACTURER'S NUMBER IS OBSOLETE. REBILL, USING NEW NUMBER.
96 161 DRUG REFILLS LIMITED TO 5 PER PRESCRIPTION
16 162 LCSW/LCMHC/LMFC PROVIDERS CAN ONLY BILL APPROVED PROCEDURE CODES.
16 163 TOOTH NUMBER IS MISSING
4 164 EPSDT MODIFIERS ARE VALID ONLY IN PAIRS (FOR EXAMPLE: ABAP, NMCI, NMNA, ETC...)
16 165 THE TOOTH SURFACE CODE IS MISSING
B7 166 PROVIDER NOT ELIGIBLE FOR ALL OR A PORTION OF DAYS BILLED.
97 167 REIMBURSEMENT FOR THIS SERVICE IS CONSIDERED AS PART OF YOUR PER DIEM.RATE.
16 168 EPSDT/FAMILY PLANNING INDICATOR MISSING
16 169 PRESCRIPTION NUMBER MISSING/INVALID
16 170 INAPPROPRIATE/INVALID MANUFACTURER NUMBER. REBILL, USING CORRECT NUMBER.
8 171 HOSPITAL BILLS FOR PROCEDURE 863 REQUIRE THE MD'S CPT CODE IN BOX 81A
119 172 HEARING AIDS & DISPENSING FEES LTD TO 1/EAR/3YRS. MORE NEED PA FROM THE DVHA.
50 173 DETERMINED NOT MEDICALLY NECESSARY.
35 174 CLAIM DENIED. YOUR 2 MONTH SUPPLY OF NICORETTE HAS BEEN MET.
198 175 PRIOR AUTHORIZATION DATES ARE NOT ADEQUATE FOR ALL SERVICES BILLED
18 176 THIS SERVICE IS AN EXACT DUPLICATE PER NDC NUMBER AND REFILL NUMBER.
96 177 MAINTENANCE DRUGS FOR A VSCRIPT BENEFICIARY REQUIRE A 90 DAY SUPPLY
4 178 CODE 11975ZMI IS NORPLANT IMPLANTATION; 11976ZMR IS NORPLANT REMOVAL
35 179 SMOKING CESSATION PROGRAM IS LIMITED TO SIX MONTHS FROM ORIGINAL START DATE
16 180 TOTAL DAYS BILLED ARE NOT EQUAL TO TOTAL ELAPSED DAYS
216 181 SERVICE DENIED. DVHA/PRO REVIEW INDICATES PRECERTIFICATION NOT MET.
16 182 PLEASE RESUBMIT WITH CLARIFICATION THAT SECONDARY CODE IS EITHER ICD-9 OR CPT.
16 183 THESE SERVICES REQUIRE HCPCS/CPT CODES
B7 184 PROVIDER NUMBER NOT CERTIFIED FOR THIS TIME PERIOD
198 185 CLAIM DENIED. SSI RECIPIENT. SERVICE REQUIRES PRIOR AUTHORIZATION FROM KAISER
199 186 ICD-9 SURGICAL PROC.CODE REQUIRED WHEN BILL REV.CODE 360, 361, 362, 367, OR 490.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
A1 187 DDMHS/ADAP CASE MGMT & REHAB SERVICE NOT COVERED UNDER THIS PROVIDER NUMBER
16 188 BILLED/SURGICAL DATE OF SERVICE IS INVALID AND/OR DOES NOT MATCH NOTES
35 189 90846 IS LIMITED TO 3 SESSIONS PER RECIPIENT LIFETIME. DVHA AUTH. REQUIRED FOR MORE
183 190 REFERRED/ORDERING PROVIDER MISSING/INVALID/NOT ON FILE/NOT ELIGIBLE ON DOS
97 191 PAYMENT FOR W4888 INCLUDES ALL RELATED SERVICES.
216 192 OTHER INSURANCE ATTACHMENT/MEDICARE EOMB REVIEWED AND DENIED BY DVHA.
23 193 OTHER INSURANCE HAS BEEN CONSIDERED
100 194 PAYMENT HAS BEEN RECEIVED BY BENEFICIARY FOR THIS SERVICE
150 195 CLAIM CUTBACK DUE TO MEDICARE PAYMENT
16 196 NDC IS OBSOLETE
256 197 YEARLY TREATMENT PLAN G9001 NON-COVERED FOR BENEFICIARY - NOT ENROLLED IN PCP
96 198 DESI DRUG NOT COVERED
97 199 PAYMENT DENIED. SECONDARY SURGERY INCIDENTAL TO PRIMARY SURGERY
96 200 DIET PRODUCTS NOT COVERED
A1 201 MANUFACTURER HAS NOT SIGNED REBATE AGREEMENT.
16 202 MEDICARE PAID AMOUNT ON EOMB IS MISSING OR ILLEGIBLE.
200 203 FUNDING SOURCE/ELIGIBILITY OVERLAP. RESUBMIT AS SEPARATE CLAIMS PER SERVICE
200 204 FUNDING SOURCE/ELIGIBILITY OVERLAP. RESUBMIT AS SEPARATE CLAIMS PER SERVICE
16 205 BILL SAME REVENUE CODE ONLY ONCE, PER DATE OF SERVICE.
A1 206 PRODUCT HAS BEEN REMOVED FROM THE MARKET
A1 207 NATIONAL DRUG CODE NOT COVERED WHEN RECIPIENT IS IN A NURSING HOME
197 208 ADAP "AUTHORIZATION FOR TREATMENT EXTENSION" MISSING FOR THESE DATES OF SERVICE.
119 209 OADAP PRIMARY RESIDENTIAL INTENSIVE TREATMENT IS LIMITED TO 21 DAYS PER EPISODE
16 210 WHEN BILLING FOR NONCONSECUTIVE DAYS, BILL SEPARATE ENCOUNTER CODES
16 211 WHEN BILLING FOR NONCONSECUTIVE DAYS, PLEASE BILL EACH DATE SEPARATELY.
A1 212 SERVICE NON-COVERED WHEN BILLED BY LICENSED OCCUPATIONAL THERAPIST.
96 213 SERVICE NON-COVERED WHEN BILLED BY LICENSED PHYSICAL THERAPIST.
16 214 RECIPIENT DATE OF BIRTH IS MISSING
96 215 THIS SERVICE IS NOT COVERED FOR CRT CLIENT.
16 216 RECIPIENT DATE OF BIRTH DOES NOT MATCH OUR FILES
45 217 CLAIM CORRECTION FORM NOT RECEIVED WITHIN THE 45 DAY LIMIT.
119 218 ADAP INTENSIVE OUTPATIENT TREATMENT (X9007) IS LIMITED TO 30 DAYS PER CAL.YEAR.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 219 OADAP ADOLESCENT RESIDENTIAL TX (X9005) LIMITED TO 120 DAYS PER YEAR
35 220 ELECTRONIC ADJUSTMENT ACCEPTED SEE NEW ICN
16 221 INVOICE MUST CLARIFY WHICH ITEM IS BEING BILLED AND ITS UNIT COST.
A1 222 THIS CLAIM HAS BEEN DENIED DUE TO A POS REVERSAL TRANSACTION
16 223 URGENT/ELECTIVE ADMISSIONS REQUIRE NOTIFICATION FOR PCPLUS BENEFICIARIES
16 224 MD'S CODE FOR ORTHOTICS & SUPPLIES IS 99070 WITH COMPLETE DESCRIPTION & INVOICE
A1 225 CMHC'S NOT ALLOWED TO BILL VHAP LTD/VHAP MC BENEFICIARIES UNDER THIS NUMBER.
A1 226 S9480 DAY HOSPITAL SERVICES (PARTIAL HOSP) COVERS ONLY VHAP MC BENEFICIARIES
185 227 ATTENDING PHYS NOT ELIGIBLE MEMBER OF BILLING GROUP FOR ALL/PART D.O.S. BILLED
16 228 PROOF THAT LIFETIME RESERVE DAYS WERE USED MUST BE INDICATED.
119 229 PCP ATTENDING PREVIOUSLY BILLED FOR Y0069 WITHIN 365 DAYS
16 230 NO DENIAL CODE ON ATTACHED MEDICARE EOMB
5 231 DME NOT COVERED WHEN BILLED PLACE OF SERVICE INPATIENT/OUTPATIENT
58 232 PHYSICAL THERAPY/CHIROPRACTIC SERVICES NOT COVERED WHEN POS INPATIENT/OUTPATIENT
89 233 TOTAL COMPONENT AND TECHNICAL OR PROFESSIONAL COMPONENTS CANNOT BOTH BE PAID
58 234 SUPPLIES AND MATERIALS NOT COVERED FOR PHYSICIAN WHEN POS INPATIENT/OUTPATIENT
4 235 PHYSICIAN MUST BILL MODIFIER 26 (PROF COMPONENT) WHEN POS INPATIENT/OUTPATIENT
58 236 ONLY SPEC 22 OR 7 PAID FOR CYTOLOGY/PATHOLOGY WHEN POS INPATIENT/OUTPATIENT
4 237 EPSDT MODIFIER REQUIRED FOR THIS SERVICE
133 238 A POST-TREATMENT RADIOGRAPH+THE COMPLETED CLAIM MUST BE SENT TO DDH FOR REVIEW
119 239 SMOKING CESSATION PRODUCTS LIMITED TO TWO SCRIPTS/REGIMENS PER CALENDAR YEAR
A1 240 VERMONT MEDICAID COVERS DME FOR IN-HOME USE ONLY
A1 241 DME SUPPLIER REQUIRED TO HAVE MNF ON FILE
16 242 PLEASE CLARIFY INVOICE TO EXPLAIN BILLED AMOUNT.
16 243 MEDICARE PAID DATE IS ILLEGIBLE.
146 244 ONE OF BILLED DIAGNOSIS IS INVALID, VERIFY IN CURRENT ICD CM MANUAL
16 245 AMBULANCE CERTIFICATION FORM MUST STATE ORIGIN AND DESTINATION OF AMBULANCE.
16 246 AMB.CERT. MUST STATE TYPE OF HOSPITAL ADMISSION (ER OUTPT, INPT ADMIT, OR OTHER)
16 247 CLAIM DOES NOT INDICATE BILLED AMOUNT REDUCED BY SPENDDOWN PER INSTRUCTIONS
256 248 VHAP MANAGED CARE PROGRAM COVERS ADULT DENTAL SERVICES ONLY UNTIL 11/30/2001
183 249 REFERRING PHYSICIAN NUMBER IS NOT ELIGIBLE.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 250 ADMISSION CODE IS NOT A VALID VALUE.
16 251 REVENUE CODE IS INVALID
16 252 QUANTITY OR UNITS NOT VALID FOR SERVICE BILLED.
119 253 SMOKING CESSATION PRODUCT LIMITED TO 180 DAYS PER CALENDAR YEAR
16 254 DETAIL DOS NOT WITHIN HEADER FROM DOS TO THRU DOS
A1 255 VSCRIPT/VPHARM COVERS MAINTENANCE DRUGS ONLY
16 256 RESUBMIT FOR BILLING OF NON COVERED SERVICES ONLY.
16 257 DATES ON THE ATTACHMENT-NOTES DO NOT MATCH DOS
B13 258 HOME HEALTH AGENCY HAS BEEN PAID FOR INSTITUTIONAL RESPITE CARE SERVICE.
A1 259 DISREGARD THIS DETAIL. PROCESSING ERROR.
A1 260 RECIPIENT ENROLLED IN SPECIALTY FUNDED PROGRAM WHICH DOES NOT COVER THIS SERVICE
35 261 VDH FAMILY SUPPORT WORKER SERVICES (W0083) ARE LIMITED TO A MAXIMUM OF 20 VISITS
16 262 PLEASE ATTACH OTHER INSURANCE DENIAL PRINT OUT, NOT VT MEDICAID DENIAL.
16 263 FEDERAL STERILIZATION CONSENT FORM REQUIRED.
6 264 BRATTLEBORO RETREAT PROV # RESTRICTED TO PCPLUS INPATIENT- VHAP 18+/MEDICAID 22+
16 265 REHAB THERAPY START DATE IS INVALID
198 266 THE BILLED DATE(S) OF SERVICE IS(ARE) NOT COVERED BY THE GIVEN PA.
31 267 SPECIALLY FUNDED RECIPIENT NOT ELIGIBLE FOR MEDICAID
16 268 APPROPRIATE PROCEDURE CODE FOR HMO CO-PAY IS T1015 AS OF 02/01/04.
16 269 THERAPY PROCEDURE CODE IS 9389
16 270 PCS DATE IS INVALID
16 271 THE THRU DATE OF SERVICE IS INVALID
16 272 THIS CLAIM HAS BEEN PRO-RATED -RECIPIENT WAS NOT ELIGIBLE FOR ALL DAYS BILLED
16 273 ICD-9 SURGICAL PROC.CODE REQUIRED FOR EACH SURGERY DONE. (Y570 IS NOT SURGERY)
16 274 ESTIMATED DAYS SUPPLY NOT A VALID VALUE
18 275 HISTORY INDICATES POSSIBLE DUPLICATE. IF NOT, RESUBMIT WITH SUPPORTING DOCUMENT.
252 276 RESUBMIT WITH HOSPITAL RECORDS SHOWING DATE & HOUR OF ARRIVAL & OF DISCHARGE
A1 277 THIS CLAIM WAS A PRIOR AUTHORIZATION REQUEST. CLAIM DENIED & SENT TO PA UNIT.
16 278 PROCEDURE/REVENUE CODE NOT ACCEPTED BY VT HEALTH ACCESS AND/OR DOES NOT EXIST.
96 279 NON-COVERED SERVICE.MEDICAID FOLLOWS THE SAME RULES AS YOUR COMMERCIAL INSURANCE
199 280 CPT AND ICD-9 CODES MUST INDICATE/REFLECT SAME SURGICAL PROCEDURE
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 281 CHARGES ON INSURANCE/MEDICARE ATTACHMENT DO NOT MATCH CHARGES ON CLAIM
197 282 PRIOR AUTHORIZATION HAS NOT BEEN APPROVED FOR DATES OF SERVICE.
15 283 AIR AMBULANCE REQUIRES PA & NEEDS TO BE BILLED ON A HCFA USING PROC CODE A0040
184 284 PRESCRIBING PHYSICIAN NUMBER NOT ELIGIBLE ON DOS
16 285 PHARM.MANAG'MT (90862) CAN'T BE PD SAME DOS AS PSYCHOTX (90804-90844 & 90855).
9 286 SECONDARY DIAGNOSIS CODE IS NOT CONSISTENT WITH THE AGE OF THE RECIPIENT
173 287 PRESCRIBING PHYSICIAN MUST BE AN INDIVIDUAL, NOT A GROUP NUMBER
16 288 PRESCRIBING PHYSICIAN NUMBER IS NOT ON FILE
119 289 MR GROUP THERAPY IS LIMITED TO 40 UNITS (10 HOURS) PER WEEK
8 290 CPT CODE ON UB RESTRICTED TO FIELD 81 & ONLY WHEN PA NEEDED FROM CONTRACTED PRO
119 291 DMH GROUP THERAPY LIMITED TO 2 HOURS (8 UNITS) PER DAY
16 292 BILLED AMT APPEARS INCORRECT COMPARED TO ALLOWED AMT. PLEASE VERIFY AND RESUBMIT
136 293 MEDICAID PAID DED/COINS.AMT. SUBMIT TO OTHER INSURANCE FOR REMAINING PYMT
A1 294 YEARLY TREATMENT PLAN CANNOT BE BILLED BY N0N-LOCKIN PCP PROVIDER
251 295 RECIPIENT PLACEMENT LEVEL IS NOT A VALID VALUE.
119 296 MASTECTOMY BRAS (L8000) ARE LIMITED TO 2 PER PATIENT PER CALENDAR YEAR.
182 297 INVALID MODIFIER ORDER. PLEASE CONTACT PROVIDER SERVICES WITH ANY QUESTIONS.
119 298 DISPENSING FEE LIMITED TO ONCE PER LENS WITHIN TWO YEARS.
119 299 MR GROUP THERAPY IS LIMITED TO 8 UNITS (2 HOURS) PER DAY.
251 300 CLAIM DENIED. RESEARCH INDICATES INCORRECT BILLING.
16 301 REBILL CORRECT CODE WITH TOTAL CHARGE.
A1 302 CLAIM DENIED. REBILL PAPER CLAIM WITH REQUIRED ATTACHMENTS.
16 303 THERAPY PROC CODE 9389 AND START DATE MUST BE IN ONE OF THE SURGICAL PROC FIELDS.
16 304 ORIGINAL EOMB IS NEEDED IN ADDITION TO THE ADJUSTMENT EOMB TO PROCESS THIS CLAIM
A1 305 CLAIM DENIED. MEDICARE'S ADJUSTMENT EOMB REQUIRED.
A1 306 MEDICARE REQUIRES ADDITIONAL INFORMATION. REBILL WITH FINAL DECISION AND EOMB.
A1 307 NON-CONSECUTIVE DAYS MUST BE BILLED SEPARATELY.
4 308 THIS MODIFIER IS NOT VALID FOR THE SERVICE BILLED.
96 309 THESE CONSECUTIVE/SIMILAR CODES CANNOT BE BILLED SIMULTANEOUSLY (SAME DOS)
A1 310 THIS MODIFIER/MODIFIER COMBINATION IS NOT ACCEPTED BY VERMONT MEDICAID/DVHA.
16 311 OVERLAPPING ELIGIBILITY. RESUBMIT WITH EOMB AND AN ITEMIZED STATEMENT OF CHARGES
4 312 DETAIL DENIED. THIS PROCEDURE CODE REQUIRES A MODIFIER.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
4 313 THIS PROCEDURE CODE DOES NOT REQUIRE/ALLOW A MODIFIER
4 314 DIFFERENT MEDICATIONS INFUSED ON SAME DAY NEED MODIFIER 02 OR 03 ON CODE Y9873.
16 315 PLEASE INDICATE START DATE FOR COINSURANCE DAYS
97 316 A PORTION OF THIS CLAIM WAS PREVIOUSLY PAID. RESUBMIT SEPARATELY.
4 317 DIAGNOSIS INDICATES EPSDT MODIFIER REQUIRED ON PROCEDURE CODE
119 318 REHAB THERAPIES ARE LIMITED TO A MAXIMUM OF 1 HOUR PER DAY.
119 319 REPLACEMENT LIFTER SLING (EO621) IS LIMITED TO ONE PER 365 DAYS
16 320 THIS CROSSOVER SERVICE REQUIRES A PAPER CLAIM WITH MEDICARE'S EOMB ATTACHED.
16 321 REBILL A PAPER CLAIM WITH EOMB.
96 322 CRNA'S CAN ONLY BE PAID FOR MEDICARE/MEDICAID CROSSOVER CLAIMS.
A1 323 DOCUMENTATION INDICATES HOSPICE RELATED SERVICE. BILL HOSPICE PROGRAM.
45 324 SERVICES/QUANTITIES BEING BILLED DO NOT MATCH THE ALLOWED SVCS./AMTS.ON THE P.A.
A1 325 MEDICARE LIFETIME RESERVE DAYS NOT EXHAUSTED. MEDICAID SERVICE DENIED
16 326 NAME OF INSURANCE COMPANY NOT PRESENT ON ATTACHMENT
A1 327 THIS PROCEDURE CODE VALID FOR CROSS-OVER CLAIMS ONLY. MEDICAID/MEDICARE ELIG.
16 328 MEDICARE EOMB INDICATES LGHP COVERAGE. RESUBMIT WITH DENIAL/PAYMENT EOB.
97 329 THIS PROCEDURE CONSIDERED INCORPORATED WITHIN ANOTHER CODE PER CPT4 MANUAL.
97 330 THIS SERVICE COVERED WITHIN THE REIMBURSEMENT FOR THE INITIAL/PRIMARY PROCEDURE
16 331 DOCUMENTATION REQUIRED SUPPORTING TWO SEPARATE OPERATIVE SESSIONS SAME DOS.
4 332 FREE VACCINES/TOXOIDS (EG, STATE SUPPLIED) ARE TO BE BILLED WITH MODIFIER 52.
97 333 CLIENT ENROLLED IN PCPLUS PROGRAM BUT THERE IS NO TPOI SEGMENT FOR M04- INFO ONLY
16 334 HEALTHY BABIES PROCEDURE CODES MUST BE BILLED ON SEPARATE LINES FOR EACH DOS
111 335 BILLING/ATTENDING PHYSICIAN IS NON-PARTICIPATING NON-REIMBURSEABLE
A1 336 PRIOR AUTHORIZATION HAS BEEN CHANGED RESUBMIT NEW CLAIM FOR PROCESSING
11 337 OFFICE VISIT DENIED. ONLY 59425,59426 SHOULD BE BILLED WITH PREGNANCY DIAGNOSIS.
96 338 OFFICE VISIT DENIED. POSTPARTUM CARE SHOULD ONLY BE BILLED WITH CODE 59430
A1 339 PHARMACY CLAIM DENIED. MANUAL REVIEW REQUIRED PLEASE REBILL ON PAPER
16 340 ESRD-RELATED SVCS CANNOT BE BILLED BOTH DAILY AND MONTHLY FOR SAME TIME PERIOD.
119 341 MONTHLY ESRD-RELATED SVCS ARE LIMITED TO ONE CODE/CALENDAR MONTH PER RECIPIENT
A1 342 SERVICE DENIED AS BEING SAME OR INCLUDED IN ANOTHER ON SAME DAY
197 343 INP SVCS OVER 24 HOURS FOR CRT CLIENT WITH BEHAV HEALTH DIAG REQUIRE DDMHS PA
4 344 THIS COMBINATION OF MODIFIERS USED IS NOT VALID FOR PROCEDURE CODE BILLED.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 345 ACCIDENT/OCCURENCE INDICATOR IS NOT A VALID VALUE
16 346 OCCURENCE/ACCIDENT DATE IS NOT A VALID VALUE
4 347 SUBMIT AS ADJUSTM'T TO PAID CLAIM WITH DOCUMENTATION OF MULTIPLE UNITS OR MOD.50
16 348 BILL REPAIR CODES (12001-13300) AS ONE CODE FOR TOTAL LENGTH WITHIN EACH GROUP
16 349 YOUR BILLED AMOUNT INDICATES INCORRECT CODE/BILLING
204 350 PROCEDURE CODE NOT VALID OR NOT ALLOWED FOR USE WITH A GA VOUCHER
16 351 THE INFORMATION ON THE INSURANCE ATTACHMENT IS ILLEGIBLE.
29 352 CLAIM NOT SUBMITTED TO THIRD PARTY LIABILITY IN TIMELY MANNER
96 353 CLAIM DENIED. NO PARTICIPATION IN ELECTRONIC FUNDS TRANSFER PROGRAM
18 354 EOMB STATES DUPLICATE SERVICE. RESUBMIT WITH INITIAL MEDICARE EOMB.
119 355 THE NUMBER OF LEAVE DAYS ALLOWED PER CALENDAR YEAR HAVE BEEN EXHAUSTED
16 356 NDC AGE MISMATCH
242 357 PROVIDER NOT AUTHORIZED FOR THIS SERVICE.
16 358 THE PATIENT STATUS IS NOT A VALID VALUE.
16 359 MEDICARE COVERAGE INDICATOR IS NOT A VALID VALUE
16 360 ENTER THE UNITS DISPENSED, INCLUDING THE NUMBER FOLLOWING THE DECIMAL.
8 361 BILL THE ENCOUNTER PROCEDURE CODE FOR EACH DATE OF SERVICE.
16 362 DATE THAT PHYSICIAN SIGNED THE CONSENT IS ILLEGIBLE. PLEASE CLARIFY.
16 363 HYSTERECTOMY CONSENT FORM REQUIRED.
16 364 PROVIDER SIGNATURE AND DATE ON CONSENT FORM MUST BE ON OR AFTER DATE OF SERVICE
16 365 HYSTERECTOMY CONSENT FORM MUST BE SIGNED BY RECIPIENT PRIOR TO SURGERY.
16 366 CONSENT FORM IS ILLEGIBLE. PLEASE CORRECT AND RESUBMIT IT WITH CLAIM.
16 367 EACH PROCEDURE CODE MUST HAVE A CORRESPONDING DATE OF SERVICE (SURGICAL DATE).
16 368 OPERATIVE NOTES/EXPLANATION ILLEGIBLE. PLEASE RESUBMIT WITH LEGIBLE INFORMATION.
4 369 BILL BILATERAL PROCEDURE CODE ONCE ONLY WITH MODIFIER 50 AND ONE UNIT OF SERVICE
16 370 PATIENT STATUS CODE IS NOT A VALID VALUE.
45 371 HOLD BED DAYS NOT ALLOWED FOR LEVEL OF CARE H3 OR H4.
16 372 RECIPIENT PLACEMENT LEVEL IS MISSING.
45 373 LEAVE DAYS NOT ALLOWED WHEN RECIPIENT PLACEMENT LEVEL IS HO1 OR HO2
16 374 MEDICARE COVERAGE INDICATOR IS MISSING
45 375 HOLD BEDS ARE NOT ALLOWED FOR SWING BED CLAIMS.
119 376 BILLED DAYS ARE EQUAL TO MORE THAN ALLOWED FOR BILLED MONTH
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
96 377 AS OF JULY 01, 1994 HOLD BED DAYS ARE LIMITED TO 6 CONSECUTIVE DAYS.
16 378 NURSING HOME CLAIMS AND WAIVER SERVICES CAN ONLY BE BILLED ONE MONTH PER CLAIM.
16 379 INPATIENT CLAIM DENIED AS IT WAS BILLED WITH NO ROOM CHARGE
16 380 SIGNATURE/DATE REQUIRED FOR CHANGES MADE TO THE ATTACHMENT.
16 381 PLEASE PROVIDE DOCUMENTATION OF LETTER/CLAIM SENT TO OTHER INSURANCE COMPANY
16 382 BLANKET DENIAL ATTACHMENT DATE IS MISSING OR IS VALID TILL END OF CAL YEAR ONLY
16 383 OTHER INSURANCE ATTACHMENT REQUIRES BREAKDOWN OF PAYMENT AND DENIALS.
16 384 ANOTHER PORTION OF YOUR POLICY IS TO BE CONSIDERED FOR COVERAGE.
16 385 DENIAL CODE AND EXPLANATION OF INSURANCE EOB CODE REQUIRED.
16 386 RX NUMBER MISSING OR INVALID
197 387 PRIOR AUTHORIZATION HAS BEEN CANCELLED.
119 388 AMNIOCENTESIS LIMITED TO ONCE PER PREGNANCY.
16 389 PLEASE GIVE REASON MEDICARE A BENEFITS WERE NOT PAID.
16 390 INSURANCE COMPANY REQUIRES MORE INFORMATION.
4 391 DATES ON INSURANCE/MEDICARE EOB DO NOT MATCH DATES OF SERVICE ON CLAIM.
22 392 THIS SERVICE IS NOT COVERED BECAUSE OF NONCOMPLIANCE WITH OTHER INSURANCE RULES.
16 393 PLEASE ATTACH A COPY OF YOUR MEDICARE DETERMINATION FORM
18 394 EOB STATES DUPLICATE SERVICE. RESUBMIT WITH INITIAL INSURANCE ATTACHMENT.
16 395 CLARIFY/INDICATE WHICH SERVICE (OR PART OF TOTAL) THIS UNLISTED CODE REPRESENTS.
23 396 NO BENEFITS DUE-MEDICAID POLICY THE SAME AS MEDICARE/INSURANCE FOR THIS SERVICE
16 397 MEDICARE EOB SHEET IS INCOMPLETE OR INVALID. PLEASE CORRECT AND RESUBMIT
102 398 INSURANCE ATTACHMENTS SHOW MAJOR MEDICAL PENDING.
16 399 PLEASE RESUBMIT W/INVOICE SHOWING WHAT YOU PAID FOR SERUM OR OTHER EXPLANATION
16 400 PLEASE BILL MEDICARE FIRST
251 401 MEDICARE (PART A) ATTACHMENT NOT VALID FOR SERVICES BILLED ON THIS CLAIM TYPE.
16 402 SERVICE(S) ON INSURANCE ATTACHMENT ARE MISSING OR DO NOT MATCH CLAIM
111 403 NO CROSS-OVER PAYMENT DUE. PROVIDER DID NOT ACCEPT ASSIGNMENT
16 404 INDICATE AMOUNT PAID BY INSURANCE COMPANY ON THE FRONT OF THE CLAIM FORM.
29 405 CLAIM/DETAIL DENIED, NOT FILED WITHIN THE TIME FRAME ALLOWED
16 406 BENEFICIARY NAME ON INSURANCE\MEDICARE ATTACHMENT DOESNT MATCH CLAIM.
204 407 SERVICE NON-COVERED FOR BENEFICIARY ENROLLED IN PDP (PHARMACY DISCOUNT PROGRAM)
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
22 408 PLEASE BILL OTHER INSURANCE CARRIER FIRST
16 409 PLEASE PROVIDE DATES OF SERVICE ON INSURANCE ATTACHMENT, SIGN AND RESUBMIT.
119 410 PSYCH ENCOUNTERS PER RECIP/PER BILLING PROVIDER/PER CALENDAR YEAR EXCEED LIMIT
B11 411 RECIPIENT INELIGIBLE FOR A PORTION OF DAYS BILLED
B11 412 PATIENT UNAUTHORIZED FOR NURSING HOME FOR A PORTION OF DAYS BILLED.
22 413 RECIPIENT HAS ANOTHER INSURANCE TO BE CONSIDERED.
16 414 PLEASE RESUBMIT INDICATING NUMBER OF TESTS PERFORMED.
16 415 TREATMENT OF ACCIDENTAL INJURY MUST BE PROVIDED WITHIN 72 HOURS OF THE ACCIDENT
96 416 DIAGNOSIS/SITUATION DOES NOT WARRENT EMERGENCY ROOM SERVICE.
A1 417 THIS "LOCK-IN" RECIPIENT CAN ONLY BE TREATED BY SPECIFIC PROVIDER
29 418 CLAIM PAST TIMELY FILING LIMITATION
16 419 PLEASE PROVIDE NAME OF BENEFICIARY ON INSURANCE ATTACHMENT, SIGN & RESUBMIT.
A1 420 WHEN MEDICARE MAKES PAYMENT, BILL ON UB92. OTHERWISE, BILL ON A NURSING HOME TAD
111 421 NO COINSURANCE OR DEDUCT. DUE. PROVIDER DID NOT ACCEPT ASSIGNMENT FROM MEDICARE.
16 422 PLEASE RESUBMIT WITH SUPPLIER'S/MANUFACTURER'S INVOICE ATTACHED
119 423 PRIOR AUTHORIZATION IS EXHAUSTED WITH THIS PAYMENT.
16 424 PLEASE SEND CLAIM/ATTACHMENTS TO DVHA FOR CONSIDERATION OF LATE BILLING.
197 425 PLEASE SUBMIT CLAIM/ATTACHMENTS TO DVHA FOR REQUIRED PRIOR AUTHORIZATION.
16 426 PAYMENT CANNOT BE MADE WHEN PA IS STATUS I OR S
197 427 MEDICAL NECESSITY AND PRIOR AUTHORIZATION REQUIRED
16 428 REQUIRED ATTACHMENT MUST HAVE AUTHORIZED SIGNATURE.
59 429 VT MEDICAID REIMBURSEMENT FOR MULTIPLE SURGERY APPLIES TO TWO PROCEDURES ONLY.
16 430 UNLISTED PROCEDURES REQUIRE DOCUMENTATION. RESUBMIT W/NOTES AND/OR EXPLANATION
16 431 INFORMATION ON MEDICAL NECESSITY FORM DOES NOT MATCH CLAIM
16 432 PLEASE RESUBMIT WITH A MEDICAL NECESSITY FORM.
169 433 PRICING WILL BE OR WAS MANUALLY REVIEWED
16 434 CLAIM DENIED-REQUESTED DOCUMENTATION NOT RECEIVED
16 435 HCPCS HAS A SPECIFIC CODE FOR THIS MEDICATION. SEE THE CURRENT HCPCS LISTING.
16 436 DETAIL DENIED. INADEQUATE OR INSUFFICIENT INFORMATION PROVIDED
16 437 INAPPROPRIATE PROCEDURE/REVENUE CODE. REFER TO YOUR LIST OF ALLOWED CODES.
15 438 PA DOES NOT MATCH. VERIFY INFORMATION SENT TO PRO CONTRACTOR/DVHA/ISSUER OF PA.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
45 439 PRIMARY SURGERY IS MANUALLY PRICED AT 100% OF ALLOWED AMOUNT
45 440 SECONDARY SURGERY IS MANUALLY PRICED AT 50% OF ALLOWED AMOUNT
54 441 ASSISTANT AT SURGERY IS PROHIBITED WITH THIS PROCEDURE CODE, PER FEDERAL POLICY
16 442 PLEASE REMOVE OTHER INSURANCE AMOUNT IF IT IS NOT FROM A THIRD PARTY CARRIER.
A1 443 WAIVER CASE MANAGEMENT SERVICES NOT ALLOWED FOR DATES OF SERVICE BILLED.
16 444 THE APPROPRIATE CODE FOR A COMPOUND DRUG IS 99100-1001-00
16 445 NOTES/CONSENT INCOMPLETE AND/OR ILLEGIBLE. PLEASE CORRECT AND RESUBMIT.
15 446 REHAB TX START DATE MISSING OR > 4 MONTHS BEFORE DOS (> 4 MOS OF REHAB NEEDS PA)
16 447 NOTES/CONSENT/INVOICE/ATTACHMENT(S) INVALID.
16 448 ATTENDING PROVIDER NUMBER MUST BE AN INDIVIDUAL PROVIDER NUMBER.
16 449 REHABILITATIVE / HOSPICE SCS SHOULD BE BILLED AS 1 UNIT PER DATE OF SERVICE
8 450 NOT ALLOWED TO BILL THIS CODE AS YOU ARE NOT AUTHORIZED FOR THE LAB SPECIALTY
16 451 COMPOUNDS NEED INGREDIENTS, INGREDIENT NDC'S, QUANTITY AND COMPUTATION OF COST.
16 452 THE QUANTITY OF INGREDIENTS USED IN THE COMPOUND DRUG MUST BE LISTED
16 453 NOT BILLED ACCORDING TO COMPOUND PRICING FORMULA
97 454 ANESTHESIA BY THE OPERATING MD IS INCLUDED WITHIN THE SURGERY CODE PAYMENT
119 455 PROCEDURE MAY BE BILLED IN ONLY ONE UNIT OF SERVICE PER SAME DATE OF SERVICE.
16 456 THIS SERVICE REQUIRED TO BE PROVIDED IN SESSIONS OF AT LEAST ONE-HALF HOUR(U=2)
16 457 NDC INDICATES THE PREGNANCY INDICATOR MUST BE A 1
45 458 CLAIM PRICED AT VERMONT MULTI-SOURCE DRUG PRICE
16 459 TAPE BILLING PROVIDER NOT ELIGIBLE TO BE BILLED FROM THIS SUBMITTER.
6 460 NON-COVERED SERVICE-RECIPIENT AGE 21 OR OVER
4 461 LAB INDICATOR INDICATES PROCEDURE WAS PROCESSED OFF-SITE. MODIFIER 26 REQUIRED.
A1 462 PROCESSING ERROR, THIS CLAIM IS BEING RESUBMITTED
16 463 TREATMENT AND PLAN OF CARE MUST BE DOCUMENTED
16 464 DIAGNOSIS RESTRICTED TO "ADULTS". STATEMENT NEEDED TO VERIFY THIS DIAGNOSIS.
7 465 PROCEDURE CODE IS NOT CONSISTENT WITH RECIPIENT'S SEX
6 466 PROCEDURE CODE/SERVICE NOT ALLOWED FOR THIS AGE (OF BILLED BENEFICIARY).
16 467 REVENUE CODE 762 IS THE CORRECT REVENUE CODE FOR OBSERVATION SERVICES.
16 468 CODE 59430 IS FOR THE MOTHER'S SIX-WEEK POSTPARTUM CHECK UP.
16 469 MEDICAL NECESSITY SIGNATURE/DATE IS MISSING/INVALID/ILLEGIBLE.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
8 470 99 CODE NOT PERMITTED UNLESS PRIMARY SURGEON USED OR WAS PAID FOR SAME PROC CODE
16 471 FRAMES AND LENSES ARE ONLY BILLABLE BY SOLE-SOURCE SUPPLIER.
B15 472 ASSIST. SURGEON CANNOT BE PAID UNTIL PRIMARY SURGEON HAS BEEN PAID FOR THIS CODE
B15 473 DENTAL PROCEDURE D0275 MAY ONLY BE PAID WHEN BILLED WITH PROCEDURE D0272
16 474 PLEASE RESUBMIT WITH COMPLETE HOSPITAL RECORD
16 475 DATE OF DELIVERY MUST BE ON CLAIM WHEN BILLING D&C FOR POST PARTUM HEMORRHAGE
10 476 DIAGNOSIS CODE IS NOT CONSISTENT WITH THE RECIPIENT'S GENDER
18 477 THIS COMPOUND DRUG IS A DUPLICATE SERVICE PER RX AND REFILL NUMBER.
16 478 ASSISTANT SURGEON MUST USE THE SAME PROCEDURE CODE USED BY THE PRIMARY SURGEON
197 479 PSYCHIATRIC/EMOTIONAL DISORDERS/ SUBSTANCE ABUSE REQUIRE PA FROM PRO CONTRACTOR.
16 480 EXPLANATION REQUIRED RE. MEDICAL NEED FOR GENERAL ANESTHESIA WITH THIS PROCEDURE
97 481 D&C FOR POSTPARTUM HEMORRHAGE NOT COVERED IF PERFORMED WITHIN 7 DAYS OF DELIVERY
16 482 RESUBMIT WITH AUTHORIZED SIGNATURE FROM DDH WHEN YOU ARE BILLING TOOTH (33)
16 483 AMOUNT PAID BY OTHER INSURANCE SHOULD BE INDICATED IN THE PRIOR PAYMENT FIELD.
97 484 THESE SERVICES ARE COVERED IN FEE PAID FOR TOTAL OB CARE
16 485 BENEFICIARY NUMBER MISSING ON MEDICAL NECESSITY FORM.
8 486 THE ONLY DVHA-COVERED CHIROPRACTIC SERVICE IS SPINAL MANIPULATION
16 487 MODIFIER 22 NEEDS PROCEDURE NOTES AND AN EXPLANATION TO JUSTIFY INDIVIDUAL CONSIDERATION.
50 488 NITROUS OXIDE NONCOVERED FOR PROVIDER/PATIENT CONVENIENCE.
96 489 CHIROPRACTIC MANIPULATION IS COVERED ONLY FOR SUBLUXATION OF THE SPINE.
16 490 THIS NDC IS NOT VALID FOR DATE OF SERVICE BILLED.
16 491 INDIVIDUAL'S EXPECTED DATE OF DELIVERY (SEE CONSENT FORM) NEEDED FOR PROCESSING.
251 492 EPSDT INDICATOR MUST BE YES IF EPSDT PROCEDURE CODES ARE BILLED.
16 493 MULTIPLE ERRORS ON CONSENT FORM. PLEASE CONTACT COMMUNICATIONS FOR ASSISTANCE
16 494 SEPARATE ER VISITS MUST BE BILLED SEPARATELY. DO NOT COMBINE INTO ONE CLAIM/BILL
16 495 RECIPIENT'S SIGNATURE ON CONSENT FORM MUST BE ON OR BEFORE DATE OF SERVICE
16 496 DATES OF SERVICE ON CLAIM AND CONSENT FORM DISAGREE.
96 497 RECIPIENT MUST BE 21 TO LEGALLY SIGN THE FEDERAL STERILIZATION CONSENT FORM.
16 498 DATE OR DATES ON CONSENT ARE ILLEGIBLE. PLEASE CLARIFY THEM AND RESUBMIT.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 499 STERILIZATION CAN BE PAID ON 31ST DAY-30 FULL DAYS MUST PASS AFTER PATIENT SIGNS
119 500 STERILIZATION MUST BE 180 DAYS OR LESS FROM DATE CONSENT SIGNED BY RECIPIENT
8 501 PROCEDURE ON CONSENT FORM MUST AGREE WITH CLAIM
16 502 CONSENT FORM INCOMPLETE
16 503 DATE OF HOSPITAL ADMISSION ON OCCUPANCY CERTIFICATION FORM IS INVALID.
16 504 RESUBMIT WITH OP NOTES AND/OR EXPLANATION OF PROCEDURE/SITUATION.
150 505 DATA SUBMITTED DOES NOT SUBSTANTIATE PROCEDURE (OR REVENUE CODE) BILLED.
197 506 OUR FILE SHOW NO N.H. AUTHORIZATION FOR DATE OF SERVICE.
A1 507 APPLIED INCOME NOT CURRENT ON ELIG FILE, CONTACT DISTRICT OFFICE FOR CORRECTION
16 508 RESUBMIT WITH NOTES, MED/SURG HISTORY AND DISCHARGE SUMMARY
78 509 CLAIM DENIED. LEAVE DAYS NOT COVERED
119 510 CLAIM DENIED. MAXIMUM LEAVE DAYS EXCEEDED.
16 511 PLEASE RESUBMIT WITH EXPLANATION OF MEDICAL NECESSITY
50 512 BENEFICIARY NOT AUTHORIZED FOR THE RPL FOR ALL/PORTION OF DAYS BILLED.
B13 513 CLAIM DENIED. INDEPENDENT LAB HAS ALREADY BEEN PAID FOR THIS SERVICE.
50 514 SUBMITTED DATA DOES NOT JUSTIFY MEDICAL NECESSITY OF ITEM(S) PROVIDED.
96 515 DENIED. STERILIZATION CONSENT MUST BE GIVEN AT LEAST 72 HOURS PRIOR TO PROCEDURE
16 516 PLEASE SUBMIT WITH ADMISSION HISTORY (INCL.SURGICAL) AND DISCHARGE SUMMARY.
16 517 PLEASE SUBMIT WITH DATA AND EXPLANATION SUBSTANTIATING PROCEDURE/TIME/UNITS
119 518 THIS ITEM LIMITED TO TWO UNITS PER 365 DAYS PER RECIPIENT
16 519 PLEASE RESUBMIT EXPLAINING HOW MUCH TIME WAS SPENT FOR THE BILLED PROCEDURE
16 520 PLEASE RESUBMIT EXPLAINING WHY D AND C WAS MEDICALLY NECESSARY.
50 521 DATA SUBMITTED DOES NOT SUBSTANTIATE MEDICAL NECESSITY
50 522 D&C NOT MEDICALLY NECESSARY. REBILL, OMITTING D&C-RELATED SERVICES.
16 523 PROCEDURE 99360 REQUIRES DOCUMENTATION OF MD'S TIME & SERVICES BEYOND THE NORMAL
16 524 PRIOR AUTHORIZATION IS NOT VALID.
96 525 BENEFITS FOR REMOVAL/REPAIR OF ORGANS INJURED DURING SURGERY ARE NOT PROVIDED
16 526 RESUBMIT WITH LAB AND/OR XRAY RESULTS
16 527 ALL ITEMS BILLED MUST BE DOCUMENTED AND JUSTIFIED ON MEDICAL NECESSITY FORM.
16 528 JUSTIFICATION REQUIRED FOR MEDICAL NECESSITY FOR THIS LENGTH OF STAY
16 529 RELEVANT HISTORY REQUIRED FOR PROCESSING (HOSPITAL,OFFICE,ETC.REORDS SHOWING HX)
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
45 530 PAID HOME VISITS ARE LIMITED TO 24 DAYS/YEAR; MORE THAN 2 DAYS/MONTH NEED REVIEW
16 531 DOCUMENTATION FOR GRAFT CODES MUST INCLUDE SIZE OF DEFECT, IN SQUARE CENTIMETERS
15 532 NURSING HOME NAME IN THE REMARKS FIELD DOES NOT MATCH NH AUTHORIZATION ON FILE.
216 533 CLAIM SUSPENSION DUE TO DSW REVIEW OF PER DIEM RATES.
23 534 CLAIM HAS ALREADY BEEN PAID BY INSURANCE CARRIER.
96 535 MEDICARE DENIAL IS "CO" (CONTRACTUAL OBLIGATION). MEDICAID SHOULD NOT BE BILLED.
96 536 STERILIZATION-RELATED SERVICES (INCL.W222)ALLOWED OUTPATIENT ONLY.
16 537 LEAVE DAYS ON NURSING HOME CLAIM DO NOT MATCH FROM/THRU DATES OF SERVICE.
119 538 NORPLANT CONTRACEPTIVE SYSTEM COVERED ONCE IN 5 YEARS, PER RECIPIENT.
119 539 APPLIANCE THERAPY IS LIMITED TO ONCE PER TWO YEARS
16 540 BENEFICIARY NUMBER IS MISSING
16 541 LAB INDICATOR IS MISSING
8 542 NON-INJECTED MEDS FOR HOME USE ARE TO BE BILLED BY PHARMACY PROVIDERS
16 543 ADMISSION CODE "1" IS NOT SUPPORTED BY THE ATTACHED DOCUMENTATION.
197 544 PRIVATE ROOM CHARGES REQUIRE PRIOR AUTHORIZATION OF MEDICAL NECESSITY.
16 545 THE SIGNATURE IS MISSING ON THE OCCUPANCY CERTIFICATION FORM.
16 546 ADJUST TO INCLUDE OUTPATIENT PRE-OP SERVICES ON INPATIENT BILL/CLAIM.
16 547 BILLED VS. ALLOWED AMOUNTS INDICATE INVALID PROCEDURE OR MODIFIER OR UNITS.
59 548 SEE ANESTHESIA SECTION OF CURRENT CPT FOR GENERAL/REGIONAL ANESTHESIA SERVICES
16 549 SPECIAL PROGRAM/EPSDT/FAMILY PLANNING INDICATOR IS NOT A VALID VALUE
5 550 ICD-9-CM PROCEDURE CODES (VOLUME 3) ARE NOT ALLOWED ON HCFA CLAIMS.
8 551 THIS REVENUE CODE IS RESTRICTED TO SPECIFIC PROVIDERS
16 552 INSURANCE ATTACHMENT SHOWS CLAIM PENDING. RESUBMIT WITH FINAL DECISION.
111 553 MANUFACTURER NOT PARTICIPATING IN VERMONT SCRIPT REBATE PROGRAM
16 554 AN OCCUPANCY CERT FORM MUST BE ATTACHED TO HOLD BED SERVICES
16 555 SPLIT & RESUBMIT AS CROSSOVER AND STRAIGHT CLAIM PER MEDICARE EOMB
16 556 BILL SAME CODE ONLY ONCE, WITH MULTIPLE UNITS TO INCLUDE ALL SERVICES.
16 557 THE SIGNATURE DATE ON THE OCCUPANCY CERTIFICATION FORM IS MISSING.
111 558 BEHAVIORAL HEALTH SERVICE DENIED. BENEFICIARY NOT CRT ON DOS.
96 559 THIS BRATTLEBORO RETREAT PROVIDER # RESTRICTED TO INPATIENT AGE 0-21 PA REQ
15 560 PRIOR AUTHORIZATION IS FOR A DIFFERENT PROVIDER/PROVIDER NUMBER.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
197 561 AUTHORIZATION BY DDH REQUIRED FOLLOWING COMPLETION OF PROCEDURE.
96 562 ORAL EVALUATIONS (D0120-50) ARE LIMITED TO ONE PER PATIENT PER PROVIDER PER DAY.
198 563 PAYMENT REDUCED TO MATCH AUTHORIZED DAYS
16 564 OCCUPANCY CERT FORM SHOULD INDICATE 100PERC OCCUPANCY FOR EACH HOLD BED DATE ON CLAIM
8 565 THIS SURGERY IS NOT COVERED FOR AMBULATORY SURGICAL CENTERS
96 566 INCORRECT BILLING OF MEDICARE EXHAUSTED BENEFITS.CONTACT PROV. SERV. FOR HELP.
16 567 PLEASE BILL ONE DATE OF SERVICE ON OUTPATIENT DETAILS AND INCLUDE MONTH-DAY-YEAR
96 568 CLAIM DENIED. BILLED AMOUNT EXCESSIVE FOR SERVICES SUBMITTED. REVIEW AND REBILL.
119 569 OADAP RESIDENTIAL DETOXIFICATION LIMITED TO 7 DAYS PER ADMISSION
16 570 OUR HISTORY FILES SHOW NO BILLING FOR MOTHERS DELIVERY ON UB92 CLAIM FORM.
B23 571 CLAIM DETAIL DENIED. NO CURRENT CLIA IDENTIFICATION ON FILE.
16 572 ADMISSION DATE SHOULD BE EQUAL TO OR PRIOR TO THE HEADER FROM DATE OF SERVICE.
B11 573 OUR FILE SHOWS RECIPIENT NOT AUTHORIZED FOR ALL DATES BILLED. PATIENT EXPIRED
16 574 MD PRESCRIPTION GIVEN DOES NOT COVER ALL THE DATES OF SERVICE BEING BILLED
16 575 DRUGS FOR HOME/SCHOOL MUST BE BILLED AS ONE LINE FOR TOTAL UNITS.RECOUP & REBILL
9 576 PRIMARY DIAGNOSIS IS NOT CONSISTENT WITH RECIPIENT'S AGE
16 577 THIS CLAIM TYPE REQUIRES A DETAIL DATE OF SERVICE FOR EACH LINE BILLED.
16 578 PRESCRIBING PHYSICIAN ON CLAIM DOES NOT MATCH PA.
16 579 BRAND CERTIFICATION INDICATOR NOT A VALID VALUE
119 580 MAINTENANCE ON OXYGEN CONCENTRATORS LIMITED TO ONCE EVERY TWO MONTHS
16 581 RECIPIENT NAME IS MISSING
197 582 AUTHORIZATION OR MANUAL PRICING IS REQUIRED BY DEPARTMENT VERMONT HEALTH ACCESS
96 583 DATE OF DISCHARGE OR DEATH NOT REIMBURSEABLE (WHEN BILLED DAYS EQUAL ZERO)
16 585 MEDICARE PAID AMOUNT IS ILLEGIBLE
197 586 PARTIAL HOSPITILIZATION FOR CRT CLIENT WITH BEHAVORIAL HEALTH DIAG REQUIRES PA
16 587 NOTICE OF DECISION SPENDDOWN ATTACHMENT INVALID
B20 588 REIMBURSEMENT HAS ALREADY BEEN MADE TO ANOTHER PROVIDER
119 589 OADAP INDIVIDUAL TREATMENT (X9000) LIMITED TO 5 UNITS (1 HOUR,15 MINS) PER DOS
119 590 MAXIMUM DOLLAR AMOUNT FOR PROGRAM HAS BEEN MET
197 591 CARDIAC REHAB REQUIRES DSW PA FOR MORE THAN 36 SESSIONS
111 592 CLAIM DENIED. NO ELECTRONIC FUNDS TRANSFER AGREEMENT ON FILE.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 593 CLAIM HAS MULTIPLE ERRORS. CONTACT PROVIDER SERVICES IF YOU NEED ASSISTANCE
16 594 CLAIM MUST STATE BILLING FOR BABY UNDER MOTHER'S ID NUMBER
119 595 ADAP GROUP OUTPATIENT (X9001 OR X9011) IS LIMITED TO 8 UNITS (2 HOURS) PER DOS
96 596 ADAP GROUP OUTPATIENT (X9001) MUST BE PROVIDED FOR AT LEAST ONE-HALF HOUR (U=2)
16 597 RECIPIENT NAME ON CLAIM DOES NOT MATCH NAME ON NOTES AND/OR CONSENT.
45 598 COCHLEAR (RE)PROGRAMMING LIMITED TO A MAXIMUM OF 18 HOURS PER 365 DAYS/PATIENT
16 599 BENEFICIARY NAME IS MISSPELLED.
16 600 DOCUMENT DRUG'S NAME,STRENGTH,EXACT QUANTITY USED,AND ROUTE OF ADMINISTRATION.
50 601 RADIOLOGY SERVICES DONE FOR THE PURPOSE OF COMPARISON ARE NOT COVERED
24 602 CLAIM PAID AMOUNT GREATER THAN BILLED DUE TO PAYMENT POLICY
16 603 COPY OF PRO'S "RETROSPECTIVE REVIEW CASE SUMMARY" REQUIRED FOR LATE BILLING.
197 604 MORE THAN ONE HOSPITAL VISIT PER DAY,SAME DIAGNOSIS AND PROVIDER REQUIRES P.A.
119 605 NURSING HOME SERVICE PRICED AT 60 DAYS PER CALENDAR YEAR - VHAP RECIPIENT
16 606 PLEASE RESUBMIT YOUR NEW CLAIM WITH YOUR RURAL HEALTH PROVIDER NUMBER
119 607 DME COMPRESSOR NEBULIZERS (E0570) ARE LIMITED TO ONE PER 3 YEARS.
119 608 OBSTETRICAL DELIVERY PAYMENTS ARE LIMITED TO ONCE IN NINE MONTHS.
96 609 THIS OPTOMETRY SERVICE IS NON-COVERED PRIOR TO DOS 7-1-89.
16 610 PSYCHOTHERAPY NOT TO BILL IN UNITS GREATER THAN ONE.
B15 611 PRESCRIPTION AND FIT OF CONTACT LENSES CANNOT BE PAID UNTIL LENS ITSELF IS AUTHORIZED
119 612 DISPENSING FEES FOR FRAMES,CASE AND LENSES MAY ONLY BE BILLED ONE TIME / 2 YEARS
119 613 COST OF LENSES MAY ONLY BE BILLED ONE TIME PER TWO YEARS
96 614 BOTH SURGICAL & MEDICAL BENEFITS NOT ALLOWED FOR SAME VISIT/SERVICE.
16 615 (Y0069) RECIPIENT NOT ENROLLED WITH ATTENDING PROVIDER AS PCP ON DOS
50 616 DOCUMENTATION SUBMITTED DOES NOT JUSTIFY NEED FOR AIR AMBULANCE -
16 617 SIGNATURE DATE ON OCCUPANCY CERTIFICATION FORM IS PRIOR TO DOS ON CLAIM.
16 618 TYPE OF BILL INDICATES CLAIM WHICH SHOULD HAVE ROOM CHARGES BILLED.
31 619 THE MEDICAID ID NUMBER ON OCCUPANCY CERTIFICATION FORM DOES NOT MATCH CLAIM.
16 620 BENEFICIARY NEEDS TO PROVIDE DVHA WITH NAME OF CURRENT INSURANCE COMPANY.
16 621 D3310 LIMITED TO TEETH 6,7,8,9,10,11,22,23,24,25,26,27,56,57,58,59,60,61,62,63,64,65,66,67
96 622 THIS IS A NON-COVERED SERVICE FOR THIS PROVIDER
16 623 DVHA COVERS SEALANTS D1352 ONLY ON PERMANENT TEETH 1-32
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
45 624 THE MAX ALLOWED UNITS/$$ FOR THIS HEALTHY BABIES ASSESSMENT HAS BEEN REACHED.
16 625 REVENUE CODE IS NOT CONSISTENT WITH THE PROVIDER TYPE - VERIFY PROVIDER # BILLED
16 626 DENTAL PROC CODES D3230, D3240, D7111 ALLOW PRIMARY TEETH A TO T, AS TO TS
16 627 EPSDT/FAMILY PLANNING INDICATOR IS NOT A VALID VALUE
16 628 TOOTH SURFACE CODE IS NOT A VALID VALUE
96 629 SEALANTS COVERED ONLY ON TOOTH #'S 02 03 14 15 18 19 30 31 OR SURFACE IS INVALID
16 630 DDMHS INDICATES NO CRT STATUS FOR DATES OF SERVICE.
16 631 PROVIDER SPECIALTY/REVENUE CODE MISMATCH
16 632 DIAGNOSIS CODE BILLED IS NOT SUBSTANTIATED BY DOCUMENTATION.
16 633 OTHER INSURANCE PYMT NOT APPLICABLE FOR HWU (ACCS) & HDR (DAY HEALTH REHAB)
16 634 THE NUMBER OF UNITS BILLED IS NOT DOCUMENTED BY THE NOTES &/OR CLAIMS' HISTORY.
54 635 CASES INVOLVING CO-SURGERY CANNOT ALSO BILL ASSISTANT SURGEON CHARGES
B12 636 ELECTRONIC VOID ADJUSTMENT ACCEPTED
16 637 THE FACILITY NAME IS MISSING ON THE OCCUPANCY CERTIFICATION FORM.
45 638 THE MAXIMUM ALLOWED ($176/30DAYS) FOR INFUSION PUMP RENTAL HAS BEEN REACHED.
96 639 MASTECTOMY FORMS (L8020 & L8030) ARE LIMITED TO ONE PER SIDE PER CALENDAR YEAR.
96 640 RESPITE FOR CAREGIVERS(W0114) IS LIMITED TO 1 PER DAY, 2 PER MONTH.
119 641 IEP/ISFP DEVELOPMENT (X0070) IS LIMITED TO A MAXIMUM OF TWO PER 275 DAYS.
B20 642 A PORTION OR ALL OF THESE DAYS WERE PAID AS A NURSING HOME CLAIM
110 643 DATE OF SERVICE IS AFTER THE JULIAN DATE CLAIM WAS RECEIVED OR DOS IS IN FUTURE.
16 644 THE SIGNATURE DATE ON THE OCCUPANCY CERTIFICATION FORM IS ILLEGIBLE.
119 645 D.O.E. PHYSICIAN IEP W0069YE IS LIMITED TO TWICE PER 305 DAYS.
16 646 THE EFFECTIVE AND THRU DATES OF SERVICE MUST BE THE SAME MONTH AND YEAR.
16 647 THE RECIPIENT NAME ON THE OCCUPANCY CERTIFICATION FORM DOES NOT MATCH THE CLAIM.
16 648 CLAIM DENIED. DATE OF SERVICE ON CLAIM IS PRIOR TO PROCEDURE DATE ON P.A.
16 649 USE ZEROES FOR 2ND, 3RD AND 4TH CHARACTERS WHEN BILLING PROCEDURE CODE G0001.
96 650 THIS BENEFICIARY IS NOT ENROLLED IN PCPLUS FOR THIS DATE OF SERVICE
16 651 ATTACHMENT MUST STATE IF PATIENT ABLE TO BE SAFELY TRANSPORTED BY OTHER MEANS
252 652 PATIENT'S SURGICAL HISTORY (NAME OF PROCEDURES, DATES & PROVIDERS) REQUIRED
16 653 TOTAL DAYS BILLED ARE NOT EQUAL TO COVERED DAYS IN BOX 7 ON CLAIM.
119 654 96117 IS LIMITED TO 8 UNITS - HOURS PER YEAR - 365 DAYS
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 655 MODIFIERS RT, LT & RTLT NOT VALID AND/OR NOT ACCEPTED ON THIS PROCEDURE CODE
96 656 AMBULANCE SERVICE PAID FOR BY HOSPITAL WHERE TRIP ORIGINATES. CLAIM DENIED.
16 657 PLEASE SUBMIT PROCEDURE D7880 FOR RECIPIENTS OVER 21 ON A HCFA-1500 CLAIM FORM.
24 658 NO PAYMENT DUE, CAPITATED PAYMENT RECEIVED FROM PRIMARY INSURANCE
119 659 PERIODONTAL SCALING & ROOT PLANING (D4341) IS LIMITED TO 4 UNITS (QUADRANTS)/YR.
150 660 PROVIDER REQUESTED ADJUSTMENT(UNIT DOSE) - ALL UNITS RETURNED - CLAIM RECOUPED
119 661 WAIVER RESPITE CARE LIMITATION MET PER CALENDAR YEAR PER BENEFICIARY
96 662 NURSING HOME NOT AT MAX OCCUPANCY FOR ALL/PORTION OF HOLD BED DAYS BILLED.
45 663 PAYMENT REDUCED TO MAXIMUM ALLOWABLE AMOUNT FOR PDP (PHARMACY DISCOUNT PROGRAM)
96 664 THIS CLAIM WILL EXCEED THE 24 LEAVE DAYS ALLOWED PER CALENDAR YEAR.
97 665 PAYMENT FOR THIS SERVICE IS INCLUDED IN THE ASC PAYMENT RECEIVED
16 666 THE ONLY DENTAL PROCEDURE CODE ALLOWED ON THE HCFA CLAIM TYPE IS D7880.
251 667 THE RECIPIENT MEDICAID ID NUMBER IS MISSING ON THE OCCUPANCY CERTIFICATION FORM.
16 668 SIGNATURE OTHER THAN PATIENT'S REQUIRES COMPETENCY STATEMENT, PER FEDERAL REG'S
B20 669 CLAIM PAID ZERO DUE TO VA DENTAL CLINIC PROGRAM PROCESSING.
16 670 AMBULANCE ATTACHMENT NOT SIGNED BY PHYSICIAN, RN OR LPN CERTIFYING MED NECESSITY
31 671 CHOICES FOR CARE ELIGIBILITY DOES NOT MATCH SERVICE AND/OR DOS, PLEASE VERIFY AND REBILL
16 672 THIS CLAIM IS ALREADY AWAITING REVIEW. TECHNICAL DENIAL AS DUPLICATE SUBMISSION
272 673 87536 AND ITS COMPONENT CODES CANNOT BE BILLED SIMULTANEOUSLY.
4 674 MODIFIER 51 ALLOWED ONLY ON SECONDARY SURGICAL CODE THAT REQUIRES PRIOR AUTH.
16 675 ROUTINE MAMMOGRAPHY SCREENING (76092) IS NOT REIMBURSEABLE UNDER BCCT PROGRAM
16 676 BILLING PROVIDER NUMBER IS ONLY AUTHORIZED TO BE THE ATTENDING PROVIDER
16 677 D3320 ALLOWS TOOTH # 4, 5, 12, 13, 20, 21, 29, 29, 54, 55, 62, 63, 70, 71, 78, 79
60 678 THE HOSPITAL BILLED THIS STAY AS OUTPATIENT. INPATIENT SERVICES CANNOT BE PAID.
119 679 THE MAXIMUM OF $200 PER DAY PER CLIENT FOR MR SERVICES HAS BEEN MET
B13 680 CLAIM DENIED. EQUIPMENT PURCHASES INCLUDE REIMBURSEMENT FOR ASSEMBLYING.
119 681 REPAIRS LTD TO ONCE/YR PER AID. SPECIFY BOTH SERIAL #S & DATES IF DIFFERENT AIDS
16 682 CONTACT LOCAL SOCIAL WELFARE OFFICE FOR SPEND DOWN LETTER AND RESUBMIT CLAIM.
16 683 THE NUMBER OF UNITS ON PHARMACY CLAIMS IS LIMITED TO FOUR DIGITS.
242 684 THIS CLAIM IS DENIED-NO AUTHORIZATION TO SUBMIT ELECTRONICALLY - CONTACT DXC
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
96 685 DAY HOSPITAL (X2876) CANNOT BE BILLED WITH CHEMO, GROUP, PSYCHOTHERAPY OR DAY RX
2 686 CLAIM PROCESSED AS MEDICARE PART A. CLAIM RECOUPED. RESUBMIT AS MEDICARE PART B
18 687 DENIED FOR THERAPEUTIC DUPE
B11 688 OUR FILES INDICATE RECIPIENT NOT ENROLLED IN HOSPICE FOR ALL/PORTION OF DAYS.
197 689 PRIOR AUTHORIZATION / DIVISION FOR CHILDREN WITH SPECIAL HEALTH NEEDS REQUIRED
96 690 FEDERALLY QUALIFIED HEALTH CENTER CODES W1040,W1050, T1015 ARE LIMITED TO ONE PER DAY
45 691 BILLED AMOUNT EXCEEDS NORM. VERIFY SERVICE CODE, UNITS AND USUAL/CUSTOMARY CHARGE.
16 692 CLARIFICATION OF MEDICARE/INSURANCE DENIAL NEEDED TO PROCESS THIS CLAIM.
16 693 NON-MANAGED CARE RECIPIENT. MUST USE Y570 THERAPY CODE
96 694 ANESTHETIC MANAGEMENT LIMITED TO ONE METHOD PER PATIENT FOR SAME DATE OF SERVICE
B7 695 THIS BRATTLEBORO RETREAT # RESTRICTED TO VHAP PCPLUS INPATIENT AGE 18 +
16 696 THIS DENTAL PROCEDURE CODE DOES NOT ALLOW THE TOOTH NUMBER BILLED
16 697 DETAIL DIAGNOSIS POINTER MISSING/INVALID OR NO DIAGNOSIS FOR POINTED FIELD
22 698 THRU DATE OF SERVICE REFLECTS MEDICARE'S COVERED DAYS
16 699 HOSPITALIZATION STAMP FROM THE DDH IS REQUIRED WITH INPATIENT DENTAL SERVICES
49 700 VT MEDICAID DOES NOT REIMBURSE FOR CARE OF CORNS AND CALLUSES
16 701 CLAIM/DETAIL DENIED. PLEASE RESUBMIT WITH ANESTHESIA RECORD(S).
96 702 THIS SERVICE NOT COVERED FOR PERSONS OVER 21 UNLESS FOR PRESURGICAL DIAGNOSIS
58 703 THE PLACE OF SERVICE CODE IS INVALID FOR THIS SERVICE.
8 704 PROCEDURE/REVENUE CODE NOT CONSISTENT WITH PROVIDER TYPE.
8 705 PROCEDURE/REVENUE CODE NOT CONSISTENT WITH PROVIDER SPECIALTY.
11 706 PROCEDURE CODE/REVENUE CODE/HCPCS CODE NOT CONSISTENT WITH DIAGNOSIS.
B22 707 PLEASE RESUBMIT WITH A MORE SPECIFIC DIAGNOSIS
16 708 PRIMARY DIAG CAN'T BE EXTERNAL CAUSE OF INJURY CODE
97 709 POSTPARTUM CARE (59430) INCLUDED IN OTHER PAID/BILLED OB CODE/SERVICE.
16 710 PLEASE USE APPROPRIATE PROVIDER NUMBER ASSIGNED FOR THIS SERVICE
197 711 CHIROPRACTIC VISITS FOR BENEFICIARIES LESS THAN 12 YRS.OLD REQUIRES PA
58 712 DOCUMENTATION &/OR RECORDS &/OR RESEARCH INDICATES THE BILLED POS IS INCORRECT.
4 713 HISTORY AND/OR CLAIM'S DESCRIPTION/NOTES INDICATES MODIFIER IS NEEDED.
96 714 SAME MD (ATTEND.PROV.#) CANNOT BE BOTH THE SURGEON & THE ASSISTANT SURGEON (80)
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 715 BOTH THE ANESTHESIOLOGIST & CRNA MUST USE SAME PROCEDURE CODE & APPROP. MODIFIER
96 716 SERVICE NON-COVERED FOR ADULTS EFFECTIVE 07/29/2002 PER LEGISLATIVE CHANGES
96 717 VHAP MANAGED CARE NON-COVERED DENTAL BENEFIT. RECIPIENT 18 YEARS OR OVER
119 718 ADJUSTABLE OSTOMY BELTS (W1547) ARE LIMITED TO 6 PER YEAR (365 DAYS).
16 719 SERVICE COVERED AS FEE FOR SERVICE - MUST BILL PAPER/TAPE NOT ENCOUNTER CLAIM
16 720 PHARMACY CLAIM HAS A NEGATIVE UNIT OF SERVICE. RESUBMIT NEW CLAIM.
11 721 REVENUE CODE NOT CONSISTENT/ALLOWED WITH DIAGNOSIS.
16 722 PRIMARY DIAGNOSIS FOR A SURGERY CANNOT BE A V-- ("WELL-CARE") DIAGNOSIS CODE.
119 723 HEALTHY BABIES ASSESSMENT (W0073) IS LIMITED TO TWICE PER PREGNANCY.
119 724 HEALTHY BABIES ASSESSMENT (W0074) IS LIMITED TO TWICE PER 12 MONTHS (365 DAYS).
2 725 REBILL MEDICARE USING THE CORRECT HIC NUMBER.
119 726 HEALTHY BABIES SERVICES W0075 & W0084 ALLOW A MAXIMUM OF 9 VISITS PER PREGNANCY.
119 727 HEALTHY BABIES SERVICES W0076 & W0084 LIMITED TO A MAX OF 15 VISITS/PREGNANCY.
119 728 THIS HEALTHY BABIES SERVICE IS LIMITED TO A MAXIMUM OF 10 VISITS PER 12 MONTHS.
119 729 THIS HEALTHY BABIES SERVICE IS LIMITED TO A MAXIMUM OF 40 VISITS PER YEAR.
119 730 PSYCHIATRIC DIAGNOSTIC AND EVALUATION INTERVIEWS LIMITED TO 5 UNITS/CALENDAR YR.
119 731 GROUP PSYCHOTHERAPY WEEKLY LIMIT REACHED
119 732 DOH HEALTHY BABIES GROUP EDUCATION (W0082) IS LIMITED TO 6 CLASSES PER 365 DAYS.
16 733 PLEASE INCLUDE CHARGES FOR OBSERVATION ROOM ON ROOM CHARGE LINE.
16 734 NEED COMPLETED COPY OF FEDERAL STERILIZATION CONSENT FORM OR HISTORY & OP NOTES.
16 735 REV. CODE 636 NEEDS HCPCS CODE OR NDC. COVERAGE LTD TO SPECIFIED CONDITIONS/DIAG
252 736 ELECTRONIC ADJUSTMENT REJECTED - ORIGINAL CLAIM NOT FOUND
22 737 ELECTRONIC ADJUSTMENT REJECTED - ORIGINAL CLAIM NOT IN A PAID STATUS
97 738 COST OF ADMINISTERING MEDICINE ALREADY INCLUDED IN PRIMARY CODE.
251 739 RHC/FQHC SUPPLEMENTAL SERVICE BILLED WITHOUT MC PAYMENT AS OTHER INSURANCE
119 740 IEP COMPREHENSIVE EVALUATION (X0069) IS LIMITED TO ONCE PER 3 YEARS PER CHILD.
16 741 TOOTH NUMBER IS INVALID.
119 742 WEEKLY CASE MANAGEMENT T1016 TL IS LIMITED TO SIX UNIT PER CALENDAR WEEK.
96 743 WEEKLY MANAGEMENT (X0071) AND 3-YEAR-EVAL (X0069) CANNOT BE PAID IN SAME MONTH.
256 744 SERVICE NOT COVERED WITHIN SCOPE OF DEPT OF CORRECTIONS PROGRAM
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 745 CHIROPRACTIC VISITS LIMITED TO 10 DOS PER CALENDAR YEAR
199 746 WHEN BILLING Y570 WITH SURGERY, ICD SURGICAL PROCEDURE CODE MUST BE IN FIELD 80.
119 747 FOR CODES 77420, 77425 & 77430, AS OF DOS 08/01/95, ONE UNIT EQUALS 5 TREATMENTS
16 748 INCORRECT RECIPIENT NAME ORDER.
A1 749 SERVICE DENIED BY THE OFFICE OF ORAL HEALTH
96 750 MAINTENANCE DRUGS REQUIRE A MINIMUM 60 DAY SUPPLY.
96 751 SEALANTS (D1351 AND D1352) LIMITED TO SURFACES (O,B,L,OB,AND OL) ONLY
119 752 PERMANENT CROWNS LIMITED TO 1 PER TOOTH EVERY 2 YEARS
35 753 PULPOTOMY (D3220) LIMITED TO ONCE PER TOOTH PER LIFETIME
35 754 ROOT CANAL THERAPY LIMITED TO ONE PROCEDURE PER TOOTH PER BENEFICIARY LIFETIME.
2 755 PLEASE BILL RAILROAD MEDICARE CARRIER.
119 756 ENDODONTIC IMPLANTS LIMITED TO 1 PER TOOTH PER 2 YEARS
35 757 D4260,D4270,D4271,&D4280 TOGETHER CANNOT BE BILLED MORE THAN 4 TIMES/LIFETIME
119 758 SRS TARGETED CASE MANAGEMENT (W0048) IS LIMITED TO ONCE PER CALENDAR MONTH.
B7 759 AS OF DOS 01/01/03, W1132 & W1133 ARE FOR PARTS ONLY. SEE E1340 FOR LABOR CHARGE
119 760 PROCEDURE D4340 IS LIMITED TO ONCE PER YEAR, ANY PROVIDER
119 761 PAYMENT FOR DENTURES (ONE UPPER & ONE LOWER) IS LIMITED TO ONCE PER 5 YEARS.
119 762 PROCEDURES D5730-D5760 LIMITED TO 1 PER 180 DAYS
119 763 PROCEDURES D5820-D5840 LIMITED TO 1 PER 365 DAYS
35 764 EXTRACTIONS LIMITED TO ONCE PER TOOTH PER LIFETIME
119 765 BITEWINGS ARE LIMITED TO 4 UNITS PER DATE OF SERVICE PER DDH
96 766 PARTIAL RADIOGRAPHS CANNOT BE BILLED ON SAME DOS AS A COMPLETE SERIES (0210).
35 767 PROCEDURES D8460-D8580 LIMITED TO 4 UNITS PER LIFETIME
119 768 D0272 AND D0274 LIMITED TO ONE UNIT PER 180 DAYS FOR ANY PROVIDER.
45 769 MENTAL RETARDATION SERVICES ARE LIMITED TO $200 PER DAY PER CLIENT
182 770 CHIROPRACTOR CAN ONLY BE ATTENDING ON HCFA
119 771 PREFABRICATED CROWNS LIMITED TO 1 PER TOOTH/2 YEARS, ANY PROVIDER
3 772 CLAIM PAYMENT REDUCED BY REQUIRED VHAP CO-PAY.
96 773 DDMHS PARTIAL HOSPITALIZATION NOT ALLOWED SAME DAY AS OTHER DDMHS SERVICES
96 774 DENTAL PROCEDURES D5212 AND D5214 CANNOT BE BILLED TOGETHER ON THE SAME DATE
198 775 CHIROPRACTOR CANNOT BE ATTENDING ON UB92 OR PRESCRIBING ON PHARMACY
96 776 PAYMENT FOR SURGERY INCLUDES RELATED POST-OP VISITS (FED.GLOBAL SURGERY POLICY)
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 777 DENIED SERVICE, PLEASE SEE HEADER EOB INFORMATION
96 778 DENTAL PROCEDURES D5730 AND D5750 CANNOT BE BILLED TOGETHER ON THE SAME DATE
96 779 BOTH THE PANEL AND ITS COMPONENT CODES CANNOT BE BILLED FOR THE SAME DOS.
96 780 DENTAL PROCEDURES D5740 AND D5760 CANNOT BE BILLED TOGETHER ON THE SAME DATE
198 781 UNITS BILLED ON CLAIM EXCEED UNITS AUTHORIZED ON PRIOR AUTHORIZATION
16 782 RECIPIENT ELIGIBLE FOR PHARMACY/CROSS-OVER SERVICES ONLY
119 783 ENTERAL SUPPLIES (B9998) ARE LIMITED TO A MAXIMUM OF $220 PER CALENDAR MONTH
204 784 THIS SERVICE IS NON-COVERED FOR VHAP PARMACY BENEFICIARY
204 785 INPATIENT SERVICES NON-COVERED FOR VHAP LIMITED RECIPIENTS.
204 786 NURSING HOME SERVICES NON-COVERED FOR VHAP LIMITED SERVICES.
204 787 THIS SERVICE IS NON-COVERED FOR VHAP LIMITED RECIPIENTS.
204 788 OTC SERVICES NON-COVERED FOR VHAPRX AND VHAP LIMITED RECIPIENTS.
B15 789 CLIENT CANNOT RECEIVE BOTH OUTPATIENT AND RESIDENTIAL TREATMENT ON SAME DOS
35 790 THIS SERVICE/ITEM LIMITED TO ONCE PER BENEFICIARY LIFETIME.
24 791 HEALTHY VERMONTERS PHARMACY PROGRAM CLAIM
96 792 REFRACTION (92015) NOT COVERED FOR ADULTS PER 2002 LEGISLATIVE MANDATE
16 793 SAME X-RAY/INTERPRETATION ON SAME DAY REQUIRES DOCUMENTATION OF NECESSITY.
119 794 CAST MATERIALS/SUPPLIES ARE LIMITED TO ONE UNIT AND TYPE PER DOS.
1 795 RECIPIENT ENROLLED IN MCO. NONCOVERED AS FEE FOR SERVICE.
B7 796 PROVIDER TYPE INVALID FOR SUBMISSION OF ENCOUNTER CLAIMS FOR MCO RECIPIENTS.
190 797 DENIED. SERVICE INCLUDED IN MEDICAID REIMBURSEMENT FOR NURSING HOME STAY.
2 798 MEDICARE PART B CLAIM RECOUPED DUE TO INCORRECT PROCESSING ERROR.
97 799 CLAIM/DETAIL DENIED AS INCLUDED WITHIN A PREVIOUS BILLED SERVICE. PLEASE ADJUST.
16 800 MORE THAN ONE SURGERY, SAME DOS, REQUIRES ADMISSION HISTORY & PROCEDURE/OP NOTES
B20 801 ANOTHER PROVIDER HAS ALREADY BEEN PAID FOR THE SAME/SIMILAR SERVICE.
119 802 A MAXIMUM OF FIVE HOME VISITS PER MONTH ARE ALLOWED BY THE SAME PROVIDER
119 803 ONLY 5 OFFICE VISITS PER MONTH ARE PERMITTED FOR THE SAME PROVIDER
119 804 ONLY ONE HOSPITAL VISIT PER DAY IS ALLOWED FOR SIMILAR OR THE SAME DIAGNOSES
119 805 NURSING HOME VISITS ARE LIMITED TO FIVE PER MONTH
119 806 VITAMIN B12 INJECTIONS ARE LIMITED TO ONE PER MONTH
119 807 SPINAL ORTHOSES LIMITED TO 1 PER 365 DAYS
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
234 808 INJECTIONS SUCH AS 62310-19 & 01996 INCLUDED IN PAYMENT FOR GENERAL ANESTHESIA
45 809 CARE OF OCULAR PROSTHESIS (V2624) LIMITED TO TWICE PER EYE PER YEAR (365 DAYS).
97 810 INCLUDED WITHIN OR IDENTICAL TO A CONCURRENTLY BILLED SERVICE.
119 811 AMBULANCE TRIPS LIMITED TO ONE UNIT PER DAY PER PROVIDER
16 812 DDMHS GROUP THERAPY SESSIONS MUST LAST A MINIMUM OF 1 HOUR (UNITS=4)
119 813 DISCHARGE DAY MANAGEMENT LIMITED TO ONE PER HOSPITAL STAY PER RECIPIENT.
119 814 CHEMOTHERAPY TREATMENT IS LIMITED TO ONE UNIT PER DAY AND 4 UNITS PER WEEK.
45 815 DIAGNOSIS AND EVALUATION LIMITED TO 4 HOURS/MONTH OR $192/MONTH PER RECIPIENT
119 816 GROUP THERAPY IS LIMITED TO 40 UNITS (10 HOURS) PER WEEK.
119 817 PSYCHOTHERAPY IS LIMITED TO FIVE HOURS PER WEEK
119 818 DAY ACTIVITY IS LIMITED TO FIVE PER WEEK.
B15 819 CODE CANNOT BE PAID UNLESS PRIMARY SURGERY IS AUTHORIZED+CODE IS SUBSTANTIATED
96 820 THIS PSYCHOLOGICAL/PSYCHIATRIC PROC.MAY ONLY BE BILLED IN ONE UNIT OF SERVICE.
45 821 PSYCHOTHERAPY PYMTS. APPROACHING MAX. ALLOWED. IF EXTENSION NEEDED, APPLY NOW.
16 822 RECIPIENT CANNOT BE CLASSIFIED AS BOTH MH AND MR/DD FOR THE SAME DATE OF SERVICE
119 823 MAXIMUM OF $500 PER YEAR LIMIT HAS BEEN REACHED.
119 824 PSYCHOLOGICAL TESTING (90830/96100) IS LIMITED TO 5 HOURS PER YEAR (365 DAYS).
45 825 PAYMENT REDUCED TO MAXIMUM ALLOWED FOR TOTAL OB CARE.
45 826 ADULT DENTAL BENEFITS APPROACHING MAXIMUM ALLOWED AMOUNT FOR THIS PATIENT
119 827 ADULT DENTAL'S MAXIMUM ALLOWED AMOUNT HAS BEEN REACHED FOR THIS RECIPIENT
119 828 PROCEDURES W9184 AND 90830 LIMITED TO 5 HOURS A YEAR.
B13 829 TOTAL OB CARE CANNOT BE BILLED BECAUSE PRENATAL VISITS ALREADY PAID.
119 830 PRENATAL VISITS AND TOTAL OB CARE CANNOT BE BILLED FOR THE SAME PREGNANCY
B13 831 TOTAL OB CARE CANNOT BE PAID BECAUSE PARTIAL OB CARE ALREADY PAID
16 832 FOR FOLLOW UP INPATIENT CONSULTATIONS USE THE APPROPRIATE SUBSEQUENT CARE CODE.
16 833 AMBULANCE CERTIFICATION FORM MISSING
96 834 AN MD PROVIDING ACTUAL TREATMENT CANNOT ALSO BILL AS A CONSULTANT
16 835 PLEASE RESUBMIT WITH NOTES INDICATING DATE AND PROVIDER OF ORIGINAL SURGERY
97 836 POST-OP CARE IS INCLUDED WITHIN THE SURGICAL SERVICE REIMBURSEMENT
16 837 NEW PATIENT PROCEDURE CODES ARE NOT ALLOWED FOR ESTABLISHED PATIENTS.
B13 838 ROUTINE MAMMOGRAPHY SCREENING (76092) FOR BCCT CLIENT WAS PAID BY DOH
16 839 SUBSEQUENT CONSULT FOR RELATED CONDITION: USE ESTAB.PATIENT MEDICAL CODE
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 840 PLEASE RESUBMIT WITH COPIES OF THE APPROPRIATE INITIAL CONSULTATION RECORDS
97 841 CAST APPLICATION INCLUDED IN PRICE PAID FOR FRACTURE WITH REDUCTION FOR 30 DAYS
272 842 OBSERVATION ROOM VISITS AND ER VISITS CANNOT BOTH BE BILLED FOR THE SAME DOS.
119 843 PRENATAL VISITS LIMITED TO 15 PER YEAR
119 844 INITIAL CONSULTS ARE LIMITED TO ONE PER PATIENT FOR SIMILAR DIAGNOSES
97 845 THESE SERVICES INCLUDED IN PREVIOUSLY PAID ECG WITH STRESS TESTING
150 846 MORE THAN 1 ADMISSION TO SAME FACILITY WITHIN 30 DAYS NEEDS REVIEW OF ADMISSION HISTORIES
119 847 WEEKLY RADIATION THERAPY MANAGEMENT (77420-77430) IS LIMITED TO 5 UNITS PER WEEK
119 848 ADMISSION CODES LIMITED TO ONE PER PROVIDER SPECIALTY PER DOS
35 849 PA REQUIRED FOR MORE THAN TWO CONTACT LENSES PER LIFETIME
35 850 ONE INTRAOCULAR LENS ALLOWED PER LIFETIME.
119 851 THE MAXIMUM UNITS FOR REHAB EVALUATIVE SERVICES HAS BEEN MET FOR CALENDAR YEAR
16 852 GASTROSTOMY JEJUNOSTOMY TUBES B4086 ARE LIMITED TO TWO PER 6 MONTHS
119 853 SKILLED NURSING AND INTERMEDIATE CARE FACILITY VISITS ARE LIMITED TO ONE/WEEK
119 854 PRENATAL VISITS LIMITED TO 15/YEAR FOR NURSE MIDWIVES
234 855 INDIVIDUAL SERVICES AND WAIVER CANNOT BE BILLED FOR OVERLAPPING DATES
16 856 FOR SUBSEQUENT DAYS USE SUBSEQUENT HOSPITAL CARE CODES
49 857 SERVICE INCLUDED WITHIN ROUTINE NEWBORN CARE (99431).
272 858 PROCEDURE CODES W1000 AND A9030 CANNOT BE BILLED ON THE SAME DATE OF SERVICE
119 859 ROUTINE NEWBORN CARE LIMITED TO 1 PER DELIVERY
119 860 NEWBORN RESUSCITATION LIMITED TO ONE PER DELIVERY
166 861 THIS HUD/HHS IS NO LONGER A COVERED SERVICE
119 862 DENTURE ADJUSTMENTS ARE LIMITED TO ONCE PER DENTURE WITHIN 180 DAYS.
45 863 DAILY ESRD-RELATED SERVICES CANNOT PAY MORE PER CALENDAR MONTH THAN MONTHLY SVCS
16 864 PLEASE RESUBMIT WITH COPIES OF ALL ADMISSION HISTORIES WITHIN 30 DAYS.
B14 865 ONLY ONE OFFICE/EPSDT VISIT PERMITTED PER DAY FOR SAME RECIPIENT, SAME PROVIDER
119 866 PAYMENT HAS BEEN MADE FOR MAXIMUM # ALLOWED. DVHA AUTHORIZATION NEEDED FOR MORE.
119 867 HEMODIALYSIS CODES 90935 AND/OR 90937 LIMITED TO 3 UNITS WITHIN 7 DAYS.
96 868 P.A. APPROVED FOR PURCHASE NOT RENTAL, REBILL WITHOUT MODIFIERS.
119 869 DDMHS "PARTIAL HOSPITALIZATION" (Z--50) IS LIMITED TO ONE PER DATE OF SERVICE.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 870 MAXIMUM # OF ALLOWED UNITS HAS BEEN MET (W9173 LTD TO 60 UNITS/CALENDAR YEAR)
96 871 ALLERGY VACCINES MAY ONLY BE BILLED IN 20 UNITS PER DATE OF SERVICE
96 872 OSTEOPATHIC MANIPULATIVE TREATMENT CANNOT BE BILLED IN ADDITION TO MEDICAL VISIT
16 873 INFORMATION ON ATTACHMENT IS OUTDATED. RESUBMIT WITH CURRENT INFORMATION.
119 874 REFILL TOO SOON.
119 875 PAYMENT REDUCED TO PSYCHOTHERAPY LIMITATION OF 8 UNITS PER DAY
96 876 CANNOT BILL NORMAL NEWBORN ADMIT AND SUBSEQUENT HOSPITAL VISITS FOR SAME STAY
119 877 PROCEDURE CODES X2800-X2809 LIMITED TO TWO UNITS PER DAY
119 878 GENERAL PSYCHOTHERAPY IS LIMITED TO 8 UNITS PER DAY.
119 879 DMH GENERAL PSYCHOTHERAPY (X2871,ETC.AND X4871,ETC.) LIMITED TO 28 UNITS/WEEK
B14 880 CONSULTATIONS LIMITED TO ONE UNIT PER DOS
119 881 90801 LIMITED TO 40 UNITS PER CALENDAR YEAR
96 882 DMH DAY HOSPITAL (X2876,X2876FB AND X2876TF) LIMITED TO ONE UNIT PER DAY
96 883 MH DAY TREATMENT (Z1035, Z2035, Z3035, Z5035) IS LIMITED TO ONE UNIT PER DAY
96 884 SERVICE NOT COVERED FOR CLIENT UNDER 18 YEARS ON DOS
119 885 MR MILEAGE (X3800-X3810) LIMITED TO 2 UNITS PER DAY
96 886 WHEELCHAIR REPAIRS INCLUDED IN WARRANTY FOR FIRST 12 MONTHS. CLAIM DENIED.
119 887 ECHOCARDIOGRAPHY LIMITED TO ONE PER DATE OF SERVICE.
119 888 MR/REHAB GENERAL PSYCHOTHERAPY IS LIMITED TO 28 UNITS (7 HOURS) PER WEEK
16 889 OFF-THE-SHELF SPLINTS ARE TO BE BILLED WITH PROCEDURE CODE A4570 AND AN INVOICE.
119 890 MR/REHAB DIAGNOSIS&EVAL.IS LIMITED TO 120 UNITS (30 HOURS) PER YEAR
119 891 OADAP DIAGNOSIS AND EVALUATION (X9004) LIMITED TO 20 UNITS (5HRS) PER 365 DAYS
216 892 PHARMACIST INTERVENTION DENIED BY CONSULTANT REVIEW.
16 893 SPAN OF DAYS FOR MILEAGE DOES NOT EQUAL DATES OF CLINIC VISITS.
B15 894 VHAP RX BENEFICARIES REQUIRE REFRACTION CODE 92015 SAME DAY AS E & M
119 895 ADAP SUBSTANCE ABUSE CASE MANAGEMENT (H0006) LTD.TO 30 HRS (120 UNITS)/CAL.YEAR
119 896 WAIVER SERVICES LIMITED TO ONE UNIT PER DOS
119 897 THE MAXIMUM LABOR TIME ALLOWED FOR SEATING SYSTEMS IS 5 HOURS (20 UNITS)
119 898 THE MAXIMUM LABOR TIME ALLOWED FOR SEATING SYSTEM MODIFICATIONS IS 3 HOURS (12U)
119 899 DDMHS ADAP SERVICES Z0700, Z0737 & Z0738 ARE LIMITED TO 40 UNITS (10 HRS) PER WK
119 900 ROUTINE VENIPUNCTURE FOR SPECIMEN(S) COLLECTION LIMITED TO 1 UNIT/DAY/PROVIDER
177 901 CAPITATION CLAIM RECOUPED PER DVHA- RECIPIENT NOT ENROLLED IN MCO.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 902 ANNUAL PCP PAYMENT IS LIMITED TO ONCE PER CALENDAR YR/PRIMARY PROVIDER
154 903 THE AMOUNT OF MEDICATION BEING BILLED EXCEEDS AMOUNT ORDERED BY PHYSICIAN.
24 904 ZERO PAID CLAIMS - DENTAL CLINIC PROCESSING.
119 905 DVHA PAYMENT FOR GLUCOMETERS IS LIMITED TO ONE PER PATIENT PER 5 YEARS.
96 906 WAIVER CODES X8100-X8122 CANNOT BE BILLED WITH PROCEDURE CODES X3800-X3888
96 907 ITEM IS NOT USUAL/CUSTOMARY FOR DIAGNOSIS/CONDITION INDICATED. PLEASE EXPLAIN.
16 908 NDC/MEDICATION BILLED DOES NOT MATCH MEDICATION/DESCRIPTION ON MD'S ORDER
97 909 THE MOTHER'S ADMISSION IS INCLUDED WITHIN THE OB/DELIVERY REIMBURSEMENT
119 910 VISUAL ANALYSIS AND INTERIM VISIT LIMITED TO ONE PER TWO YEARS
119 911 INTERIM VISUAL ANALYSIS LTD TO 1 PER 2 YEARS
16 912 MOST FRACTURES HEAL IN 6-8 WEEKS. WHY IS THIRD MONTH RENTAL MEDICALLY NECESSARY?
119 913 OPHTHALMOLOGICAL EXAM LIMITED TO 1/2 YEARS
35 914 THE MAXIMUM ALLOWED OF 3 ROOT CANALS PER ADULT RECIPIENT LIFETIME HAS BEEN MET
8 915 MISSING/INVALID NCPDP DATA ELEMENT
119 916 DMH/MR SPECIAL.GROUP REHAB LTD.TO 8 UNITS OR 2 HRS PER DOS
119 917 AS OF 1/1/96, DMH/MR SPECIAL.GROUP REHAB (Z**38) LTD.TO 40 UNITS (10 HRS)/CAL.WK
119 918 AMBULATORY SURGICAL CENTER FACILITY FEES ARE LIMITED TO ONE PER DOS.
4 919 AMBULATORY SURGICAL CENTERS: BILL MODIFIER SG ON YOUR PRIMARY SURGICAL PROC CODE
96 920 PROPHY.(01110, 01120) & FULL MOUTH DEBRIDEMENT (04355) CANNOT BE PAID SAME DOS.
16 921 RESUBMIT WITH SPECIFIC INFORMATION ON PATIENT'S FUNCTIONAL LIMITATIONS
16 922 NEED DOCUMENTATION THAT USE OF A LESS EXPENSIVE ITEM WAS NOT ADEQUATE.
50 923 CLAIM RECOUPED PER REQUEST OF DVHA/PRO, DUE TO NON-MEDICALLY NECESSARY DAYS.
252 924 THIS CLAIM HAS BEEN RECOUPED. YOU MAY NOW SUBMIT A NEW CLAIM WITH MEDICARE EOMB
119 925 DMH EMERGENCY CARE IS LIMITED TO 28 UNITS (7 HOURS) PER DAY.
119 926 DMH EMERGENCY CARE IS LIMITED TO 140 UNITS (35 HOURS) PER WEEK.
16 927 RESUBMIT WITH ALL ATTACHMENTS REQUIRED FOR MANUAL PRICING.
119 928 RURAL HEALTH CLINIC (W1040) AND FQHC (W1050) ENCOUNTERS LIMITED TO 5 PER MONTH
119 929 Z5036 IS LIMITED TO 20 UNITS (5 HOURS) PER DAY & 100 UNITS (25 HOURS) PER WEEK.
16 930 RESUBMIT WITH EXPLANATION OF CONTINUED USE PAST USUAL LENGTH OF NEED
119 931 ORAL HYGIENE INSTRUCTIONS (01330) ARE LIMITED TO ONCE PER YEAR (365 DAYS)
119 932 CEPHALOMETRIC X-RAY (00340) IS LIMITED TO ONCE IN TWO YEARS.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 933 DIAGNOSTIC MODELS (00470) ARE LIMITED TO ONE PER TWO YEARS.
119 934 DIAGNOSTIC PHOTOGRAPHS (00471) LIMITED TO ONCE IN TWO YEARS.
119 935 FULL MOUTH DEBRIDEMENT (D4355) IS LIMITED TO ONCE IN TWO YEARS (730 DAYS).
119 936 FLUORIDE TREATMENT IS LIMITED TO ONCE PER PATIENT PER 6 MONTHS.
97 937 IV FLUIDS USED TO MIX/ADMINISTER/FLUSH MEDS ARE INCLUDED IN IV INFUSION TX CODES
119 938 OCCLUSAL ORTHOTIC APPLIANCE LTD 1/365 DAYS
96 939 MILEAGE IS COVERED ONLY WHEN CLINIC,CASE MANAGEMENT OR REHAB SVCS.ARE PROVIDED
119 940 INITIAL ORAL EXAM D0150 LIMITED TO 1 PER PROVIDER PER 3 YEARS
119 941 PERIODIC ORAL EXAM (PROCEDURE D0120) LIMITED TO ONE PER SIX MONTHS.
119 942 ONLY ONE ORAL EXAM (INITIAL AND/OR PERIODIC) IS COVERED PER 6 MONTHS
119 943 COMPLETE SERIES RADIOGRAPHS LIMITED TO ONCE IN 6 MONTHS
96 944 INTRAORAL FILMS (00220 AND 00230) ARE LIMITED TO A MAX OF $55 PER DOS, PER PROV.
94 945 BILLED AMOUNT ON CLAIM DOES NOT MATCH THE DOLLAR AMOUNT YOU REQUESTED ON YOUR PA
96 946 BILL DME SUPPLY CODES ONLY ONCE PER CALENDAR MONTH FOR TOTAL NUMBER OF UNITS.
119 947 PANORAMIC FILM LIMITED TO 1 PER 6 MONTHS
119 948 DENTAL PROPHYLAXIS (D1110, D1120, D4910) LIMITED TO 1 PER 6 MONTHS (180 DAYS)
119 949 PIN FOR RESTORATION (D2951) LIMITED TO ONE/TOOTH/YEAR,ANY PROVIDER
108 950 DME CANNOT BE RENTED FOR LONGER THAN 3 MONTHS UNLESS APPROVAL GIVEN BY THE DVHA.
16 951 BOTH THE DATE OF PRESCRIPTION AND THE DATE OF PROVIDER'S SIGN.NEEDED TO PROCESS.
16 952 PLEASE RESUBMIT ON DME/SUPPLIES CLAIM FORM
119 953 DENTURE REPAIRS ARE LIMITED TO ONCE PER DENTURE PER 180 DAYS.
119 954 DENTAL TISSUE CONDITIONING IS LIMITED TO ONCE PER DENTURE IN 2 YEARS (730 DAYS).
119 955 RESTORATIVE TREATMENT LIMITED TO ONCE PER TOOTH/TOOTH SURFACE PER YEAR.
B22 956 DIAGNOSES DO NOT JUSTIFY ITEM/SERVICE PROVIDED AND/OR FUNCTIONAL LEVEL.
97 957 DENIED.FIRST MONTH'S 'TENS' SUPPLIES INCLUDED IN RENTAL FEE FOR E0730-RR.
16 958 RESUBMIT WITH DATE ITEM PURCHASED (OR RENTAL START DATE) AND PROVIDER OF ITEM.
8 959 ENTERAL SUPPLIES ARE LIMITED TO HIGH TECH PROVIDERS,WITH PA FROM MEDICAID
16 960 RESUBMIT WITH YOUR LABOR RATE (PER HOUR) AND THE TOTAL TIME BEING BILLED.
16 961 PLEASE RESUBMIT UNITS SHOULD EQUAL NO. OF TOTAL ITEMS IN ALL INDIVIDUAL PACKAGES
197 962 DVHA AUTHORIZATION REQUIRED WHEN SERVICE PROVIDED TO BENEFICIARY UNDER AGE 18
16 963 ITEMIZE CHARGES FOR INDIVIDUAL ITEMS: NAME, COST OF EACH AND NUMBER SUPPLIED.
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 964 RESUBMIT WITH INVOICE AND COPY OF WARRENTEE
4 965 INAPPROPRIATE CODE. PLEASE REFER TO YOUR HCPCS MANUAL.
16 966 SERVICE DATE IS BEFORE AUTHORIZED DATE IN PA NUMBER.
16 967 BILLED UNITS MUST = CHARTED TIME ONLY. 1U=15MINS. DO NOT INCLUDE THE BASE UNITS.
50 968 MEDICAL NECESSITY FORM DOES NOT DOCUMENT NEED OF ITEM
96 969 QUANTITY PROVIDED MONTHLY EXCEEDS NORMAL USAGE
16 970 PLEASE GIVE ITEMIZED LIST OF LABOR AND/OR PARTS CHARGES
97 971 THESE SUPPLIES ARE INCLUDED WITHIN THE REIMBURSEMENT OF THE EQUIPMENT RENTAL.
16 972 WHEELCHAIR PRICING REQUIRES BRAND NAME AND MODEL NUMBER
16 973 LENGTH OF NEED INDICATED ON THE MED.NECESSITY FORM CONTRADICTS BILLING RENTAL.
16 974 COMPLETE MED SUPPLIES SECTION OF MED. NEC. FORM AND INDICATE AVG. MONTHLY USAGE.
16 975 PLEASE RESUBMIT WITH MANUFACTUROR'S INVOICE OR SUGGESTED LIST PRICE
119 976 QUANTITY PROVIDED EXCEEDS ALLOWED/NORMAL AMOUNTS.
16 977 THE DATE THAT THE PHYSICIAN'S CERTIFICATION WAS COMPLETED IS ILLEGIBLE/INVALID.
108 978 INDICATED LONG TERM NEED (PER DIAGNOSIS OR >3 MOS) CONTRADICTS BILLING OF RENTAL
94 979 QUANTITY/UNITS BILLED EXCEED(S) AMOUNT APPROVED ON MEDICAL NECESSITY FORM
197 980 P.A. OR EXPLANATION REQUIRED TO JUSTIFY EXCESSIVE QUANTITIES/UNITS.
108 981 DOCUMENTATION INDICATES TEMPORARY NEED. REBILL FOR RENTAL INSTEAD OF PURCHASE.
119 982 PERIODIC (ANNUAL) EXAM LIMITED TO ONCE PER YEAR.
96 983 SERVICE COVERED UNDER SOLE-SOURCE RESPIRATORY CONTRACT THROUGH DOS 06/30/01.
171 984 ONLY SOLE-SOURCE CONTRACTOR ALLOWED OXYGEN IN NURSING HOME (POS 31,32 & 33)
16 985 ATTACHED RX IS INCOMPLETE AND/OR DOES NOT COVER SOME OR ALL BILLED DATES
119 986 DENTAL SEALANTS (D1351 & D1352) LTD.TO ONCE/TOOTH PER FIVE YEARS, ANY PROVIDER.
16 987 Y9873 NEEDS MD PRESCRIPTION (DOSAGE, FREQ., DURATION) AND NATIONAL DRUG CODE #
16 988 EXPLANATION/DOCUMENTATION NEEDED TO JUSTIFY MORE EXPENSIVE ITEM
96 989 THERAPEUTIC FOSTER CARE (-TF) AND FAMILY BASED (-FB) SERVICES ARE EXCLUSIVE
16 990 DOCUMENTATION DOES NOT JUSTIFY NEED FOR STERILE ITEM(S)
16 991 SPECIFIC INFORMATION NEEDED TO EXPLAIN WHAT THE BILLED ITEM IS BEING USED FOR.
B12 992 CLAIM RECOUPED. DXC WILL RESUBMIT NEW CLAIM WITH ORIGINAL EOMB AND ADJTM EOMB.
252 993 CLAIM RECOUPED. RESUBMIT NEW CLAIM WITH ORIGINAL EOMB AND MEDICARE ADJMT EOMB.
B12 994 AS REQUESTED THIS CLAIM HAS BEEN RECOUPED AND YOU MAY NOW RESUBMIT A NEW CLAIM.
B12 995 THIS CLAIM HAS BEEN RECOUPED PER PROV. NEW CLAIM HAS BEEN SUBMITTED FOR PROCESS
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
B12 996 THIS CLAIM IS RECOUPED BECAUSE OF PROCESSING ERROR, CLAIM WAS RESUBMITTED BY DXC
B12 997 WE HAVE SPLIT AND REBATCHED YOUR CLAIM. IT WILL SHOW AS PENDING ON YOUR NEXT RA.
B12 998 THIS CLAIM WAS RECOUPED DUE TO AN ADJUSTMENT REQUEST SUBMITTED BY DXC/DVHA
55 999 THIS CLAIM HAS BEEN RECOUPED DUE TO AN ADJUSTMENT REQUEST SUBMITTED BY PROVIDER.
16 1000 OCCURRENCE/ACCIDENT DATE IS AFTER THE FROM DATE OF SERVICE
16 1001 COPAY REIMBURSED FOR CAPITATED SERVICES ONLY
45 1002 MANUALLY PRICED UP TO THE ALLOWED NUMBER OF UNITS
16 1003 HOSPICE INPATIENT SERVICES EXCEED INPATIENT STAY
97 1004 A PORTION OF THIS CLAIM WAS PAID AS A HOSPICE CLAIM
4 1005 RESUBMIT WITHOUT A MODIFIER 76/77 AND WITH NOTES OF EXPLANATION
16 1006 SPLIT THE CLAIM ACCORDING TO AUTHORIZATION FOR HCBS OR ERC AND NURSING HOME
16 1007 THIS ADJUSTMENTIS A RESULT OF POST PAYMENT REVIEW DONE BY SUR UNIT
A1 1008 SERVICES NOT COVERED BY MEDICAID. RECIPIENT PARTICIPATING IN PACE
59 1009 CLAIM ADJUSTED/CUTBACK DUE TO MULTIPLE SURGERY POLICY
150 1010 MORE THAN ONE TIER FOR SAME OR OVERLAPPING DOS NOT ALLOWED FOR ERC.
16 1011 ATTACHED RA IS NOT LEGIBILE
B12 1012 THIS CLAIM HAS BEEN RECOUPED AS THE RESULT OF AN ADJUSTMENT REQUEST
142 1013 TBI SERVICE REDUCED BY PATIENT SHARE AMOUNT
50 1014 HPV VACCINE LIMITED TO 3 PER PATIENT PER LIFETIME
96 1015 PROGRAM COVERS COINS/DED ON DME DIABETIC SUPPLIES/J CODES SUBMITTED BY PHYSICIAN ONLY
16 1016 AS OF 1/1/07 WHEN BILLING 3 FILMS APPROPRIATE CODE IS D0273
16 1017 MAKE CORRECTIONS BASED ON HEADER OR DETAIL EOB DENIALS AND RESUBMIT NEW CLAIM
16 1018 BILLING PROVIDER NUMBER IS NOT CORRECT FOR UB92 LF FACILITY SERVICE
16 1019 BILLING PROVIDER NUMBER IS NOT CORRECT FOR HCFA LF NON-FACILITY SERVICE
96 1020 THE LADIES FIRST PROGRAM DOES NOT COVER MALE BENEFICIARIES
12 1021 LADIES FIRST PROGRAM DOES NOT COVER THIS DIAGNOSIS CODE
96 1022 LADIES FIRST SERVICE COVERED FOR AGE 40 AND OVER ONLY
119 1023 SERVICE EXCEEDS LADIES FIRST CVD SCREENING LIMIT OF 2 PER 310 DAYS
119 1024 HOME VISITS LIMITED TO 5 PER MONTH
96 1025 THIS SERVICE IS NOT COVERED UNDER THE LADIES FIRST PROGRAM
96 1026 THIS REVENUE CODE IS NOT COVERED FOR THE LADIES FIRST PROGRAM
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
96 1027 EITHER THE BILLING OR ATTENDING PROVIDER IS NOT ENROLLED IN THE LADIES FIRST PROGRAM
96 1028 THIS CLAIM TYPE IS NOT COVERED BY THE LADIES FIRST PROGRAM
252 1029 THIS LADIES FIRST PROGRAM REQUIRES A VOUCHER FOR THIS SERVICE
119 1030 HBK AND F SERVICES EXCEED UNITS ALLOWED IN 12 MONTH PERIOD WITHOUT PA
149 1031 HBK AND F SERVICES HAVE EXCEEDED THE UNITS ALLOWED PER LIFETIME WITHOUT PA
199 1032 THIS REVENUE CODE REQUIRES A HCPCS/CPT CODE FOR THE LADIES FIRST PROGRAM
23 1033 SPLIT CLAIM INTO SINGLE DETAIL CLAIMS WITH CORRECT OTHER INSURANCE FOR EACH DETAIL
96 1034 EITHER THE BILLING PROVIDER OR THE CLIENT IS NOT COVERED BY LADIES FIRST PROGRAM
16 1035 MUST BE BILLED AS NDC TO PHARMACY
96 1036 THIS LADIES FIRST DIAGNOSIS CODE IS BILLABLE ONLY FOR WOMEN AGE 40 AND OLDER
23 1037 THIS CLAIM TYPE REQUIRES OTHER INSURANCE PAYMENT SUBMITTED AT DETAIL LEVEL
45 1038 PAYMENT REDUCED TO PROVIDER MODERATE CAP BALANCE
119 1039 THIS PROVIDER'S MODERATE CARE ANNUAL CAP PAYMENT HAS BEEN MET
29 1040 RA INVALID DOCUMENTATION FOR TIMELY FILING. PREVIOUS DENIAL WAS FOR TIMELY FILING.
96 1041 SERVICES FOR MODERATE INDIVIDUALS ARE LIMITED TO REV CODE 070, 095, AND 096
16 1042 THIS SERVICE REQUIRES AN ITEMIZED BILL SENT TO LADIES FIRST AT DEPT OF HEALTH
16 1043 SEND A CLINICAL REPORT TO LADIES FIRST AT DOH FOR REVIEW PRIOR TO PAYMENT
A1 1044 THIS PROGRAM COVERS PART B DRUGS AND DIABETIC SUPPLIES ONLY ON THIS CLAIM TYPE
16 1045 SEND CLINICAL REPORT TO LF AT DOH TO CLARIFY SERVICES AS MULTIPLE ICD CM CODES WERE USED
119 1046 CASE MANAGEMENT BY HHA IS LIMITED TO 48 HOURS PER YEAR
119 1047 MODERATE SVCS FOR REV CODE 095 ARE LIMITED TO 30 HOURS PER MONTH
119 1048 MODERATE SVCS FOR REV CODE 096 ARE LIMITED TO 934 UNITS/MONTH
96 1049 VT MEDICAID DOES NOT COVER THIS SERVICE WHEN BILLED ON AN OUTPATIENT CLAIM
96 1050 DRUG SCREENINGS CANNOT REIMBURSED IF BILLED SAME DAY/SAME PROVIDER AS 82570/83986
250 1051 THE INFORMATION ON THE ATTACHED RA DOES NOT MATCH THE INFORMATION ON THE CLAIM
16 1052 RESUBMIT YOUR CLAIM WITH A COPY OF THE ORIGINAL RA THAT SHOWS PROOF OF TIMELY FILING
96 1053 THIS SERVICE IS NOT COVERED FOR THE PROGRAM THAT THE CLIENT IS ENROLLED IN
16 1054 THIS REVENUE CODE REQUIRES A CPT OR HCPCS CODE
96 1055 THIS SERVICE IS NOT VALID FOR THE DATE OF SERVICE BILLED
16 1056 THIS MODIFIER IS NOT VALID FOR THE DOS BILLED
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 1057 YOUR ELECTRONIC CERT FORM IS MISSING OR MISSING INFORMATION
119 1058 90846 IS LIMITED TO 12 PER YEAR
16 1059 DATE OF SERVICE ON THE CLAIM DOESN'T MATCH THE DATE OF SERVICE ON THE VOUCHER
15 1060 PROVIDER NUMBER ON YOUR CLAIM DOESN'T MATCH THE PROVIDER NUMBER ON THE VOUCHER
147 1061 THERE IS NO ANNUAL WAIVER MODERATE CAP AMOUNT ON FILE FOR THIS PROVIDER
16 1062 PLEASE INDICATE NURSING HOME NAME IN THE REMARKS FIELD
4 1063 MODIFIER NOT ACCEPTED AT THIS TIME. ALL MODIFERS ARE UNDER REVIEW BY DVHA.
29 1064 ONLY THE RA WITH PAID OR DENIED CLAIMS ARE ACCEPTABLE AS PROOF OF TIMELY FILING
29 1065 REQUEST FOR OVERRIDE OF TIMELY FILING HAS BEEN DENIED BY DVHA
16 1066 ONE OF THE DIAGNOSIS CODES BILLED IS NOT VALID PER ICD-CM LISTING
16 1067 THE FIELD 24E ONLY ACCEPTS DIAGNOSIS POINTERS1,2,3 OR 4 NOT THE ACTUAL DIAGNOSIS CODE
16 1068 ONE OF THE DIAGNOSIS BILLED IS NOT CONSISTENT WITH THE RECIPIENTS AGE
16 1069 , PLEASE UNDERLINE OR CIRCLE UNITS OR TIMES ON ATTACHMENTS, DO NOT HIGHLIGHT OR WHITE OUT
119 1070 METHADONE TREATMENT LIMITED TO 1 PER CALENDAR WEEK
146 1071 ONE OF THE DIAGNOSIS CODES POINTED TO IS MISSING
16 1072 PROCEDURE DENIED AS COSMETIC. RESUBMIT WITH DOCUMENTATION PROVING MEDICAL NECESSITY
18 1073 THIS SERVICE HAS ALREADY BEEN FORWARDED TO ADMINISTRATIVE SERVICES FOR PAYMENT
96 1074 THIS CLIENT CANNOT HAVE BOTH HCBS AND FLEXIBLE CHOICES SERVICES ON THE SAME DATE
31 1075 PLEASE VERIFY BENEFICIARY UNIQUE ID - NUMBER NOT ON FILE WITH LADIES FIRST
29 1076 ELEC ADJUSTMENT NOT ALLOWED. NOT ALL DETAILS MEET TIMELY FILING POLICY
140 1077 RECIPIENT NAME/NUMBER IS INCORRECT OR MISSING
16 1078 ORDERING PHYSICIAN NUMBER OR QUALIFIER IS MISSING OR NOT VALID
96 1079 ORAL HYGIENE INSTRUCTIONS D1330 CANNOT BE BILLED ON SAME DOS AS D0145
119 1080 D0220 ALLOWED ONLY ONCE PER DOS, ANY TOOTH
119 1081 G9003/G9007 LIMITED TO ONCE PER PATIENT PER YEAR
160 1082 NPI AND TAXONOMY COMBINATION INVALID FOR THIS CLAIM TYPE
8 1083 ITEM COVERED AS PHARMACY BENEFIT ONLY AND MUST BE BILLED BY PHARMACY. PA REQUIRED.
119 1084 OSTOMY RING LIMITED TO 30 PER 2 MONTH PERIOD
234 1085 CLAIM DENIED AS THE CLIENT HAS NO AUTHORIZATION FOR THIS WAIVER SERVICE.
97 1086 REIMBURSEMENT FOR ALL CHARGES INCLUDED IN DRG PAYMENT
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
96 1087 SERVICE NON COVERED FOR CHAP BENEFICIARY LIMITED TO PREMIUM ASSISTANCE ONLY.
96 1088 VERIFY RPL. OUR FILES SHOW HCBS SERVICES AUTHORIZED NOT NURSING HOME
16 1089 A CPT CODE IS REQUIRED AT DETAIL WHEN REVENUE CODE 360, 361, 362, 367 OR 490 IS BILLED
96 1090 ESI BENEFICIARY IS COVERED FOR CHRONIC CARE SERVICES ONLY
35 1091 E0243 LIMITED TO 1 PER RECIPIENT PER LIFETIME
119 1092 E8000-E8002 LIMITED TO 1 PER 3 YEARS
135 1093 INTERIM BILL NOT ALLOWED.
96 1094 MOM AND BABY SERVICES CANNOT BE BILLED ON SAME CLAIM FOR DRG PRICING
4 1095 PROCEDURE/MODIFIER COMBINATION IS NON-REIMBURSABLE
119 1096 E AND M LIMITED TO 3 PER PREGNANCY PER PREGNANCY DIAG
16 1097 NDC IS REQUIRED AND NOT SUBMITTED OR NOT ON FILE
211 1098 SERVICE DENIED. MANUFACTURER IS NOT COVERED BY A REBATE.
96 1099 CLAIM DENIED WHILE WAITING PRICING FROM DVHA
242 1100 NO RECIPIENT RATE ON FILE
133 1101 CLAIM FORWARDED TO THE OOH FOR REVIEW. PRICING AND PMT BY ADMIN SVCS.
35 1102 SITZ BATH CHAIR LTD TO ONCE PER LIFETIME
35 1103 SPOT CHECK OXIMETER RENTAL LTD TO 3 MO/LIFETIME
35 1104 CONTINUOUS W/24HR TRENDING OXIMETER RENTAL LTD 6MO/LIFE
133 1105 THERE IS NO VALID GA VOUCHER FOR THIS SERVICE
206 1106 NPI REQUIRED FOR BILLING PROVIDER
206 1107 NPI REQUIRED FOR ATTENDING/RENDERING PROVIDER
208 1108 ATTENDING PROVIDER NPI NOT ON FILE WITH VT MEDICAID. CONTACT PROVIDER ENROLLMENT.
208 1109 BILLING PROVIDER NPI NOT ON FILE WITH VT MEDICAID. CONTACT PROVIDER ENROLLMENT.
197 1110 PLEASE REQUEST A RETROSPECTIVE PA FROM DVHA
96 1111 PAID DATE BEFORE DATE OF SERVICE
206 1112 NPI REQUIRED FOR REFERRING PROVIDER
208 1113 REFERRING PROVIDER NPI NOT ON FILE WITH VT MEDICAID. CONTACT PROVIDER ENROLLMENT.
16 1114 UNIT/UNIT OF MEASURE REQUIRED FOR NDC'S
16 1115 NDC MUST BE ENTERED IN FIELD 24D
107 1116 CLAIM WAS UNABLE TO BE PRICED. PRICING DETAIL IS IN DENIED STATUS.
45 1117 INDIVIDUAL ALLOWANCE REDUCED TO NOT EXCEED CLAIM TOTAL BILLED
70 1118 ADDITIONAL OUTLIER PAYMENT
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
143 1119 PAYMENT REDUCED DUE TO PARTIAL ELIGIBILITY
97 1120 CLAIM PAYMENT REDUCED, DOLLARS ARE INCLUDED IN THE CASE RATE
96 1121 THIS SERVICE IS NOT COVERED FOR THE CASH AND COUNSELING PROGRAM
119 1122 CLAIM PAYMENT REDUCED TO RECIPIENTS FLEXIBLE CHOICES QUARTERLY ALLOTMENT AMT
199 1123 REV CODE 071 LIMITED TO HCPCS T2025, S5121, AND S5199 FOR CASH AND COUNSELING PROGRAM
119 1124 RECIPIENT'S FLEXIBLE CHOICES QUARTERLY ALLOTMENT AMOUNT HAS BEEN MET
1 1125 VHAP BENEFICIARY HAS ALREADY BEEN PAID FOR 60 DAYS OF NH SERVICES FOR THIS CALENDAR YEAR
97 1126 PAYMENT FOR THIS DETAIL IS INCLUDED IN PAYMENT FOR PRIMARY PROCEDURE
16 1127 ADMISSION DATE MUST BE EQUAL TO HEADER FROM DATE OF SERVICE
16 1128 NDC, UNITS AND UNITS MEASURE NOT IN CORRECT ORDER. PLEASE CORRECT AND RESUBMIT
16 1129 ADMISSION AND FROM DATE DO NOT MATCH
45 1130 DRUG CROSSOVER CLAIMS MUST BE SUBMITTED DIRECTLY TO MEDMETRICS
16 1131 OCCURRENCE CODE BILLED IS NOT VALID FOR REHABILITATIVE THERAPY SUBMITTED
16 1132 OCCURRENCE CODE AND THERAPY START DATE MUST BE BILLED WHEN SERVICE IS REHAB THERAPY
18 1133 OUR HISTORY FILES SHOW THIS SERVICE HAS BEEN REIMBURSED BY PBM
119 1134 CUSHION LIMITED TO 1 PER 365 DAYS
50 1135 DVHA HAS REVIEWED AND DENIED YOUR APPEAL REQUEST
35 1136 PROCEDURE LIMITED TO ONCE PER TOOTH PER LIFETIME
22 1137 PROVIDER MUST APPEAL OTHER INSURANCE AND BISHCA
45 1138 MAX ALLOWED AMOUNT FOR OB SERVICES HAS BEEN MET
108 1139 RENTAL ONLY ALLOWED FOR 1 MONTH. AFTER THAT ITEM MUST BE PURCHASED
119 1140 PURCHASE LTD 1 IN 5 YEARS
45 1141 PREVIOUS RENTAL PRICE INCLUDED IN PAYMENT FOR PUCHASE
211 1142 SERVICE DENIED, ONE OF THE MANUFACTURES IS NOT COVERED BY A REBATE
119 1143 OPHTHALMOLOGIC EXAM LIMITED TO 1 IN 2 YEARS
119 1144 ALVEOLOPLASTY LTD TO 4 QUADRANTS PER 365 DAYS
45 1145 MEDICAID RATE DECREASED BY 2 PCNT PER THE FY 2010 BUDGET ACT PASSED BY THE LEGISLATURE
96 1146 THIS PROGAM COVERS DIABETIC SUPPLIES, J CODES FOR MAINTENANCE DRUG COINS/DED ONLY
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 1147 RECIPIENT HAS MEDICARE PART C. PLEASE BILL THEIR SELECTED CARRIER
B13 1148 ALREADY PAID BY LADIES FIRST THROUGH VDH. QUESTIONS CALL LF BILLING LINE AT 865-7757
107 1149 THIS SERVICE DENIED AS NO ABN PAP RESULT ON FILE LADIES FIRST
119 1150 OXIMETER PURCHASE LTD TO 1 PER 3 YEARS PER BENEFICIARY
16 1151 TOTAL CHARGE MISSING, OR DOES NOT EQUAL THE SUM OF INDIVIDUAL CHARGES
29 1152 INVOICE/MSRP MUST BE WITHIN 1 YEAR FROM DATE OF SERVICE
16 1153 ATTACHMENT FROM A NON-SECURE WEBSITE IS NOT ACCEPTABLE
16 1154 NDC IS NOT VALID FOR HCPCS CODE BILLED
163 1155 PLEASE USE THE MEDICARE ATTACHMENT SUMMARY FORM
163 1156 THE OI AMOUNT IN PRIOR PAYMENTS FIELD DOES NOT MATCH OI PAYMENT ON ATTACHMENT
251 1157 ATTACHED DOCUMENTATION IS ILLEGIBLE
B12 1158 SERVICE PROCESSED BY THE FITP PROGRAM.
B12 1159 SERVICE PROCESSED BY THE CSHN PROGRAM.
96 1160 CSHN NOT COVERED OVER THE AGE OF 21.
96 1161 CSHN NON-COVERED SERVICE
96 1162 FITP NON-COVERED SERVICE
197 1163 CSHN SERVICE REQUIRES PRIOR AUTHORIZATION
109 1164 FITP/CSHN SERVICE PRIOR TO 01/01/2010, PLEASE BILL FITP OR CSHN DIRECTLY.
96 1165 FITP NON-COVERED SERVICE RECIP OVER AGE 3
96 1166 SERVICE NOT COVERED BY MEDICAID/DR. D/VHAP/OTHER PROGRAMS
197 1167 FITP SERVICE REQUIRES PRIOR AUTHORIZATION
177 1168 CSHN ELIGIBILITY IS INCOMPLETE
197 1169 FITP OR CSHN SERVICE REQUIRES PRIOR AUTHORIZATION
97 1170 MULTI FUNDED CLAIM - PLEASE REBILL WITH EACH DETAIL ON ITS OWN CLAIM
152 1171 SERVICE LIMITED TO 1 HOUR PER DATE OF SERVICE FOR FITP AND CSHN PROGRAMS
151 1172 MEETINGS LIMITED TO 6 UNITS PER YEAR
242 1173 THERAPY ASSISTANT NOT COVERED BY MEDICAID PROGRAM
242 1174 REGISTERED DIETICIAN CANNOT BE BILLING PROV FOR MEDICAID PROGRAM.
B12 1175 SERVICE PROCESSED BY THE LADIES FIRST PROGRAM.
16 1176 D1351 U9 ONLY COVERS TEETH A,J,K,T,4,5,12,13,20,21,28 OR 29
177 1177 FITP ELIGIBILITY IS INCOMPLETE
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
242 1178 FITP CSHN SVS ON HOME HEALTH CANNOT INCLUDE DETAIL PROCEDURE CODE, BILL JUST REV CODE
119 1179 PERSONAL CARE SERVICES LIMITED TO 1 PER DAY
149 1180 LIMITATION FOR THIS SERVICE HAS BEEN MET
119 1181 T2023 LIMITED TO 1 PER MONTH
119 1182 LIMITED TO ONE PER MONTH
119 1183 J7303 LIMITED TO 18 UNITS PER 365 DAYS
119 1184 LIMIT 96 UNITS PER DAY - ONE UNIT EQUALS 15 MINUTES
119 1185 REPLACEMENT OF REUSABLE EXTERNAL RECEIVER/MONITOR LIMITED TO ONE PER 730 DAYS / 2 YEARS
119 1186 95249 / 95250 / 95251 LIMITED TO ONCE PER 30 DAYS
119 1187 LIMITED TO TWO PER 6 MONTHS
96 1188 95249, 95250 AND 95251 LIMITED TO A MAXIMUM OF 4 TIMES PER CALENDAR YEAR
119 1189 A4456 IS LIMITED TO 50 PER 31 DAYS
23 1190 FITP TPL OVERRIDE ACCEPTED
200 1191 PAPER CROSSOVER SUBMITTED BEFORE 30 DAYS FROM MCR PAID DATE
119 1192 MULTIPLE-DENSITY INSERTS LIMITED TO 2 PER FOOT PER 365 DAYS
16 1193 RURAL HEALTH/FQHC PROVIDERS MUST BILL SVCS AND T1015
226 1194 PLEASE PROVIDE DOCUMENTATION TO SUPPORT CHANGES ON RESUBMITTED CLAIM
15 1195 REVENUE CODE ON YOUR CLAIM DOES NOT MATCH THE REVENUE CODE ON THE PA
151 1196 UNITS MUST MATCH DATE SPAN
15 1197 CODE/MODIFIER ON CLAIM DOESN'T MATCH PA. SEND CHANGE-REQUEST INFORMATION TO PA ISSUER
16 1198 USE MORE SPECIFIC DIAGNOSIS CODE FOR STERILIZATION PROCEDURE
119 1199 UNITS EXCEED YEARLY ALLOWED. PA NOT ISSUED OR DOES NOT MATCH CLAIM.
31 1201 USE BENEFICIARY UNIQUE ID INSTEAD OF SSN
119 1202 COUNSELING VISITS LIMITED TO 16 PER CALENDAR YEAR
16 1203 PA NOT ON FILE OR CLAIM DOES NOT MATCH PA
204 1204 THE CODE BILLED IS NOT REIMBURSABLE BY MEDICAID AT THIS TIME
119 1206 92608 IS LIMITED TO 10 UNITS PER 365 DAYS WITHOUT PA
119 1207 92607 IS LIMITED TO 1 UNIT PER 365 DAYS WITHOUT PRIOR AUTHORIZATION
97 1208 CIS SERVICES MAY NOT BE BILLED INDIVIDUALLY AND BUNDLED IN SAME MONTH
18 1209 EITHER BASE CODE OR BASE CODE WITH GT MODIFIER ALLOWED PER DAY
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 1210 EXCEED LIMIT 1 UNIT OF A4604 OR A7037 REIMBURSED PER 90 DAYS
119 1211 EXCEED LIMIT 1 UNIT OF A7027 OR A7030 REIMBURSED PER 90 DAYS
119 1212 EXCEED LIMIT 1 UNIT OF A7029 OR A7033 REIMBURSED PER 30 DAYS
119 1213 EXCEED LIMIT 2 UNITS OF A7028 REIMBURSED PER 30 DAYS
119 1214 EXCEED LIMIT 1 UNIT OF A7031 REIMBURSED PER 30 DAYS
119 1215 EXCEED LIMIT 2 UNITS OF A7032 REIMBURSED PER 30 DAYS
119 1216 EXCEED LIMIT 1 UNIT OF A7034 REIMBURSED PER 90 DAYS
119 1217 EXCEED LIMIT 1 UNIT A7035 REIMBURSED PER 180 DAYS
119 1218 EXCEED LIMIT 1 UNIT A7036 REIMBURSED PER 180 DAYS
119 1219 EXCEED LIMIT 2 UNITS A7038 REIMBURSED PER 30 DAYS
119 1220 EXCEED LIMIT 1 UNIT A7046 REIMBURSED PER 180 DAYS
119 1221 EXCEED LIMIT 1 UNIT A7039 REIMBURSED PER 180 DAYS
119 1222 EXCEED LIMIT 1 UNIT A7044 REIMBURSED PER 180 DAYS
119 1223 EXCEED LIMIT 1 UNIT A7045 REIMBURSED PER 180 DAYS
119 1224 PAYMENT REDUCED DUE TO INAPPROPRIATE BILLING OF COMPLEXITY LEVEL
96 1225 DETAIL DENIED. SEE DETAIL FOR REASON
119 1226 FITP/CSHN SCREENING LIMITED TO 1 PER YEAR PER PROVIDER
16 1227 PLEASE INDICATE OTHER INSURANCE PAYMENT AMOUNT ON THE MEDICARE ATTACHMENT SUMMARY FORM
4 1228 THIS PROCEDURE CODE REQUIRES MODIFIER LT OR RT
251 1229 MEDICARE ATTACHMENT SUMMARY FORM IS INCOMPLETE
15 1230 PRIOR AUTHORIZATION TYPE DOES NOT MATCH PROGRAM IN WHICH RECIPIENT IS ENROLLED
4 1231 THIS CODE IS COVERED FOR RENTAL ONLY AND REQUIRES THE RR MODIFIER.
119 1232 PARTIAL HOSPITALIZATION CODES G0410/G0411 ARE LIMITED TO 7 UNITS PER DAY
16 1233 BILL RANGE OF DATES AND ONE UNIT
16 1234 PLEASE RESUBMIT WITH VACCINE SPECIFIC DIAGNOSIS
119 1235 RENTAL OF E2402 IS LIMITED TO 1 PER MONTH
119 1236 A6550 LIMITED TO 15 UNITS PER MONTH
119 1237 A7000 LIMITED TO 10 UNITS PER MONTH
119 1238 NURSING HOME SERVICE PRICED AT 30 DAYS PER EPISODE - VHAP RECIPIENT
16 1239 THE AMOUNT IN THE BOX 54 ON YOUR CLAIM IS INCORRECT.
251 1240 BLANKET DENIAL IS MISSING THE PROVIDER SIGNATURE AND/OR DATE SIGNED
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
B15 1241 PAYMENT ADJUSTED DUE TO MULTIPLE SURGERY GUIDELINES
16 1242 CLAIM ALIGNMENT ISSUE- PLEASE CORRECT AND RESUBMIT
119 1243 99408, 99409, G0396, G0397 LTD TO 1 PER 365 DAYS
16 1244 INCLUDE CONTRACTUAL ALLOWANCE ON OI PAYMENT AMOUNT
16 1245 PLEASE SUBMIT CURRENT VERSION OF CONSENT FORM
119 1246 J7307 LIMITED TO ONCE PER THREE YEARS
B12 1247 LEVEL I PSYCH PER DIEM
4 1248 PA ON FILE FOR THIS SVC DOES NOT HAVE A MODIFIER AND CANT BE PROCESSED. PLEASE CORRECT
197 1249 THIS SERVICE REQUIRES PA BECAUSE 8 VISITS HAVE ALREADY BEEN PAID
B12 1250 PAYMENT AUTHORIZED DUE TO MEDICARE RECOUPMENT
B12 1251 PAYMENT AUTHORIZED DUE TO CBA RECOUPMENT
16 1252 CLAIMS INVOLVING CLINICAL TRIALS MUST ALSO GIVE THE RELATED CANCER DIAGNOSIS
16 1253 SUBMIT CLAIM AND ATTACHMENTS TO DVHA ATTN DENTAL APPEALS
16 1254 SUBMIT TPL CHANGE REQUESTS TO THE ADDRESS OR FAX NUMBER LOCATED ON THE TPL CHANGE R
119 1255 V5266 HEARING AID BATTERIES LTD TO 12 PER 30 DAYS
119 1256 G0476 LTD TO 1 UNIT PER 5 YEARS
223 1300 PROCEDURE IDENTIFIED AS PRIMARY IN NCCI CODE PAIRS
223 1301 UNABLE TO ELECTRONICALLY ADJUST PRIMARY CCI PROCEDURE. PLEASE SUBMIT PAPER ADJ REQ.
236 1302 SERVICE DENIED, NOT PAYABLE UNDER NCCI REGULATIONS
273 1303 DETAIL DENIED. UNITS EXCEED NCCI MAXIMUMS.
97 1309 ZERO PAYMENT - SERVICE BUNDLED
96 1310 ZERO PAYMENT - REPORTING SERVICE ONLY
146 1311 DIAGNOSIS CANNOT BE PRIMARY
22 1408 OTHER INSURANCE DENIAL CODE IS MISSING/NOT ACCEPTED. REBILL WITH A COPY OF PAYMENT/DENIAL
96 1410 90801 AND 90801-GT ARE NOT REIMBURSED ON THE SAME DAY FOR SAME RECIPIENT
96 1411 90804 AND 90804-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1412 90806 AND 90806-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1413 90808 AND 90808-GT ARE NOT REIMBRUSED ON THE SAME DAY
96 1414 90805 AND 90805-GT ARE NOT REIMBURSED ON THE SAME DAY
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
96 1415 90807 AND 90807-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1416 90809 AND 90809-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1417 90846 AND 90846-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1418 90847 AND 90847-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1419 90853 AND 90853-GT ARE NOT REIMBURSED ON THE SAME DAY
96 1420 90862 AND 90862-GT ARE NOT REIMBURSED ON THE SAME DAY
16 1421 ANESTHESIA CODES USE 15 MINUTE UNITS FOR DOS PRIOR TO 01/01/12
16 1422 PLEASE BILL MEDICARE HOSPICE FIRST AND ATTACH A COPY OF PAYMENT OR DENIAL.
16 1423 THIS CODE USES 15 MINUTE UNITS
B15 1424 ADMINISTRATION ONLY PAID WHEN VACCINE BILLED ON SAME DOS
B13 1425 PROCEDURE CODE HAS ALREADY BEEN PAID FOR SAME DATE AND SAME DIAGNOSIS
96 1426 REPAIR OF FRAME/LENSES CAN NOT BILLED ON SAME DATE AS NEW GLASSES
182 1427 PLEASE REBILL WITH EXPLANTION OF MODIFIER AM
96 1429 T1019 AND T1020 WITH OR WITHOUT MODIFIERS CANNOT BE BILLED ON SAME DOS
16 1430 SUBMIT DOCUMENTATION THAT SHOWS MORE THAN ONE VACCINE FOR THIS DX
197 1431 PRIOR AUTHORIZATION NECESSARY, SEE DMH FOR LEVEL I AUTHORIZATION
197 1432 DMH LEVEL I PRIOR AUTHORIZATION EFFECTIVE JULY 1, 2012
16 1433 PLEASE RESUBMIT WITH NOTES THAT INDICATE PROVIDER WAS A COSURGEON.
119 1434 T2025 LIMITED TO ONE PER MONTH
96 1435 G0101/Q0091 AND E/M CODES CAN/T BE BILLED ON SAME DOS
96 1436 DENIED DUE TO INAPPROPRIATE BILLING OF COMPLEXITY LEVEL
96 1437 ONLY SFI BUNDLED SERVICE CAN BE PAID FOR THE SAME DOS
16 1438 RESUBMIT WITH NOTES INDICATING GESTATION LENGTH FOR DOS
204 1439 BENEFICIARY IN LIMITED BENEFIT PROGRAM SRVS NOT COV
168 1440 INTEGRATED FAMILY SERVICES BUNDLE HAS BEEN BILLED
168 1441 INTEGRATED FAMILY SERVICES INDIVIDUAL BILLS HAVE BEEN REIMBURSED
16 1442 OTHER INSURANCE PYMT LESS THAN 3.00. RESUBMIT WITH INITIAL INSURANCE ATTACHMENT SHOWIN PYM
16 1443 REFERRING/ORDERING PROVIDER MUST BE AN INDIVIDUAL
119 1444 HEARING AIDS LIMITED 1 PER 3 YEARS
119 1445 PROC CODE V2784 IS LIMITED BASED ON BENE AGE ON DOS
147 1446 EPCP CLAIM
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
169 1447 IF MEDICARE DEDUCT OR COINS IS EQUAL OR MORE THAN BILLED AMOUNT, SEND MEDICARE EOMB
16 1448 EOMB NEEDED IN ADDITION TO MASF
96 1449 DO NOT ALLOW NON BUNDLE CODES IF BUNDLE OR MINI BUNDLE HAS BEEN BILLED
119 1450 ALLOW ONLT 1 UNIT OF SERVICE PER CALENDAR MONTH
96 1454 PROC CODE/MOD/SAME RECIP LIMITED BY PROVIDER
146 1455 DIAGNOSIS CODE VERSION INCORRECT FOR DOS
146 1456 SURGICAL PROCEDURE CODE VERSION INCORRECT FOR THE DOS
146 1457 IMPROPER ICD VERSION SUBMITTED ON PROF CLAIM
16 1458 PROC CODE/MOD/SAME RECIP LIMITED TO SPECIFIC PROVIDER
242 1459 PAY MAX DAYS ALLOWED ON PA OR WITH NO VALID PA
119 1460 DVHA ONLY COVERS EXTERNAL CEPHALIC VERSION ONCE PER PREGNANCY
97 1461 ORDERING PROVIDER NOT ACTIVE ON THE DATE OF SERVICE
35 1463 DVHA ONLY PAYS FOR ONE STERILIZATION PER RECIPIENT PER LIFETIME
16 1464 INAPPROPRIATE PCS. PLEASE REFER TO CURRENT ICD-PCS MANUAL
16 1465 CLAIMS INVOLVING CLINICAL TRIALS MUST GIVE THE RELATED CANCER DIAGNOSIS
16 1467 PRIMARY DX MUST BE FOR SUBPOPULATION REFUGEES
16 1468 REQUIRED NOTATION MISSING FROM CLAIM
119 1470 LIMIT OF 16MG PER DAY FOR BUP DRUGS
135 1471 ADMIT DATE EQUAL TO OR 1 DAY AFTER IP STAY
B15 1472 PAYMENT ADJUSTED DUE TO TRANSFER/SHORT STAY PRICING
119 1473 ONLY ONE UNIT OF ALCOHOL OR DRUG SERVICE PERMITTED PER DOS
119 1474 J7304 LTD TO 40 PER 365 DAYS
16 1475 USE APPROPRIATE NURSERY REVENUE CODES FOR ALL ROOM AND BOARD CHARGES
16 1476 V2784 WITH CORRESPONDING MODIFIERS MUST BE BILLED WITH V2100-V2499
16 1478 DOS TOO FAR INTO THE FUTURE
16 1479 PLEASE RESUBMIT WITH APPROPRIATE FORM
160 1480 QUALIFIER IS MISSING AND IS REQUIRED OR INVALID
119 1481 AREA OF ORAL CAVITY MISSING OR INVALID
16 1482 ICD VERSION INDICATOR IS INVALID OR IS MISSING
119 1483 D0230 IS LIMITED TO 5 UNITS PER DOS
119 1484 G0424 LIMITED TO 2 SESSIONS PER DAY PER BENEFICIARY
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 1485 G0424 REQUIRES A PA FOR MORE THAN 36 SESSIONS PER BENEFICIARY
96 1486 G0424 IS NOT TO BE BILLED WITH OTHER THERAPEUTIC SERVICES ON THE SAME DOS
96 1487 ANESTHETIC MANAGEMENT LIMITED TO FOUR METHODS PER PATIENT FOR SAME DATE OF SERVICE
16 1488 DO NOT PUT TOTAL CHARGES ON UB CLAIM
96 1489 THIS CLAIM WAS GIVEN INDIVIDUAL CONSIDERATION BY OUR UR DEPARTMENT AND HAS BEEN DENIED
35 1490 D0393 LTD TO 2 PER PATIENT PER LIFETIME
16 1491 NDC UNITS MUST MATCH THE UNITS BILLED
16 1492 PROVIDER NOT AUTHORIZED TO BILL THAT MANY MG
16 1493 NOTE ENTERED DOES NOT MATCH NDC BILLED
96 1494 NOTE THE DATE MCR A EXHAUSTED/STARTED, SIGN AND DATE
16 1495 INVOICE ILLEGIBLE
206 1496 NPI REQUIRED FOR SUPERVISING PROVIDER
206 1497 NPI REQUIRED FOR ORDERING PROVIDER
234 1498 DETAIL PACKAGED DUE TO COMPOSITE PRICING
150 1499 CLAIM HAS BEEN PREVIOUSLY ADJUSTED SUBMIT ON PAPER
234 1500 DETAIL PACKAGED DUE TO COMPLEXITY PRICING
16 1501 WAITING PLACEMENT MUST BE BILLED
198 1502 PRIOR AUTHORIZATION DOES NOT COVER THE WHOLE STAY. CONTACT DVHA FOR PA ADJUSTMENT
181 1503 SEQUELEA CODE NOT ALLOWED AS PRIMARY
168 1504 DONOR NAME NOT LISTED ON CLAIM
119 1505 C9448 LIMITED TO 2 PER MONTH
119 1506 C9450 LIMITED TO 19 PER 2 YEARS
16 1507 PRIMARY DIAGNOSIS CODE MISSING
B15 1508 INCORRECT ADMINISTRATION CODE BILLED
89 1509 INCORRECT NUMBER OF COMPONENTS BILLED
29 1510 TIMELY FILING APPEAL LIST OF RECIPIENTS MISSING
119 1511 SURGICAL BOOT/SHOE, EACH LIMITED 1 UNIT PER 365 DAYS
119 1513 COCHLEAR IMPLANT DEVICE ACCESSORIES LIMITED 2 PER YEAR
96 1514 L8627/ L8628 LTD TO 2 PER 3 YEARS
119 1515 L8621 LTD TO 420 UNITS PER YEAR
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
119 1516 L8614 LTD TO 1 SIDE EVERY 10 YEARS
119 1517 59430 LIMITED TO ONE PER YEAR
125 1518 SPAN OF DAYS REQUIRED
45 1520 COINSURANCE/DEDUCTIBLE IS MORE THAN THE TOTAL BILLED
146 1521 ICD-10 CODE NOT VALID BEFORE 10/01/2015
119 1522 G0249 LTD TO 1 UNIT PER 4 WEEKS
16 1523 D9310 NOT REIMBURSABLE ON SAME DOS AS ORAL EVALUATION
16 1524 ORIGINAL EOB REQUIRED
146 1525 PCS SURGICAL PROCEDURE CODE REQUIRED.
198 1526 REV CODES OR DAYS AUTHORIZED DO NOT MATCH
16 1527 0360T,0361T,0362T,0363T NOT ALLOWED ON SAME DOS AS ADAPTIVE BEHAVIOR CODES
45 1528 IF COINSURANCE MORE THAN 50 PERCENT OF BILLED AMOUNT SEND MEDICARE EOMB
96 1529 THE SURGICAL PROCEDURE CODE BILLED IS NON COVERED BY MEDICAID
251 1530 NO MEDICARE SEGMENT ON FILE FOR RECIPIENT FOR DOS ON THE CLAIM
16 1531 DATES ON MEDICARE SUMMARY FORM DO NOT MATCH DATES OF SERVICE ON FILE
4 1532 HD MODIFIER ALLOWED FOR FEMALES ONLY AGE 12-55
45 1533 COINSURANCE OR DEDUCTIBLE ON MASF DOES NOT MATCH MEDICARE EOMB
186 1534 REIMBURSMENT REDUCED DUE TO DURATION OF CARE
96 1535 ONE OF DX BILLED IS NOT COVERED
B15 1536 OCCURRENCE SPAN DATE MISSING OR INVALID
B15 1537 VALUE CODE BILLED REQUIRES A VALUE AMOUNT
119 1538 DRUG TESTS LTD TO 8 PER MONTH
16 1539 AUTHORIZED DATES DO NOT MATCH DATES BILLED
119 1540 0359T LTD TO 1 PER 365 DAYS
29 1541 ADJUSTMENT DENIED MORE THAN 1 YEAR FROM ORIGINAL PAID DATE
16 1542 DETAIL CHARGES COVERED BY MEDICARE
119 1543 PAYMENT REDUCED TO MATCH AUTHORIZED DAYS
16 1544 INCORRECT HOSPICE ADMIT DATE
119 1545 A7020 LTD TO 1 UNIT EVERY 2 MONTHS
119 1874 GROUP THERAPY 90853 LTD TO 1 SESSION PER DAY
119 1877 GROUP THERAPY 90853 LIMITED TO 3 SESSIONS PER WEEK
119 1878 90853 GROUP THERAPY LIMITED TO A MAXIMUM OF 8 UNITS / 1 SESSION PER DAY PER RECIPIENT
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 1879 ATTENDING PROVIDER TAXONOMY IS INVALID.
223 1880 ADD-ON PROC NOT ALLOWED WHEN PRIMARY PROC NOT PRESENT
132 1881 PROCESSED AS AN ACO CLAIM
4 1882 MODIFIER 76 OR 77 NOT ALLOWED IF BASE CODE HAS NOT BEEN BILLED ALONE
4 1883 PROCEDURE CODE BILLED WITH 76 OR 77 MODIFIER ONLY ALLOWED TWICE PER DOS
198 1885 DIAGNOSIS ON THE CLAIM, NOT IN RANGE APPROVED ON THE PA
96 1886 PROCEDURE CODE/TOOTH NUMBER COMBINATION NOT ALLOWED
146 1888 ICD CODE OR VERSION IS INVALID OR MISSING
70 1890 HOSPICE SIA PAYMENT
119 1891 BENEFICIARY MAX MET FOR E0935
15 1892 THE CODE/MODIFIER BILLED MUST MATCH THE CODE/MODIFIER REQUESTED ON THE PA
16 1893 USE A CONDITION CODE TO INDICATE A DISTINCT VISIT
96 1894 D9110 NOT ALLOWED ON SAME DOS AS DENTAL
96 1895 D9110 NOT ALLOWED 10 DAYS FOLLOWING DENTAL
119 1896 D1352 LTD TO 1 PER YEAR
119 1897 D3221 LTD TO ONE TOOTH PER LIFETIME
16 1898 INITIAL ADMIN ALLOWED 1 PER DOS WITH APPROPRIATE UNITS
16 1899 ADDITIONAL ADMIN ALLOWED 1 PER DOS WITH APPROPRIATE UNITS
96 1901 D3221 NOT ALLOWED ON SAME DOS AS D3230-D3330
119 1902 REPLACEMENT OF LOST OR BROKEN RETAINER LTD TO ONE PER ARCH PER PATIENT PER LIFETIME
16 1903 REVENUE CODE NOT CONSISTENT WITH PROCEDURE CODE BILLED
4 1904 MODIFIER NOT ALLOWED ON CLAIM TYPE
119 1905 OCCLUSAL GUARDS LTD TO 1 SET PER 2 YEARS
119 1906 BENEFIT MAX MET FOR H2000/HU
119 1907 THERAPEUTIC CODES LTD TO 4 UNITS PER DOS
16 1908 BENEFICIARY INELIGIBLE FOR SERVICE DUE TO NO LTC AUTHORIZATION ON FILE FOR DOS
26 1909 BENEFICIARY INELIGIBLE FOR SERVICE ON DOS DUE TO REVOKED HOSPICE ELECTION
16 1910 BILL ONLY THE LAST DOS AND ICD CODES
96 1911 H2022HE/HB NOT ALLOWED ON SAME DOS AS H2022HW
119 1912 SCALING AND DEBRIDEMENT LTD 1 PER 180 DAYS
119 1913 A4553 LTD TO 3 PER 180 DAYS
119 1914 A9285 LTD TWO PER FIVE YEARS
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
16 1915 SERVICE NOT COVERED FOR THIS DIAGNOSIS
16 1916 BILL ALL FIRST ADMINISTRATIONS PER DOS ON 1 DETAIL WITH SPECIFIC # OF UNITS
16 1917 BILL ALL ADDITIONAL ADMINISTRATIONS PER DOS ON 1 DETAIL WITH SPECIFIC # OF UNITS
119 1918 A4224 LTD TO 1 PER WEEK
97 1919 RE-EVAL AND EVAL NOT ALLOWED ON SAME DOS
96 1920 RE-EVAL AND EVAL ONLY ALLOWED ONE PER DOS
16 1921 L3257 MUST BE BILLED WITH SHOE CODE WITH LT AND RT
125 1923 A MORE SPECIFIC DX IS AVAILABLE FOR ONE OR MORE DX CODES
125 1924 A MORE SPECIFIC CODE IS AVAILABLE FOR ONE OR MORE SURGICAL PROC CODES
35 1925 REFUGEE VISITS LIMITED TO 2 PER LIFETIME
16 1926 REV CODE NOT COVERED FOR DOS BILLED
272 1927 MEMBER MUST ACCESS HOSPICE BENEFIT THROUGH MEDICARE
119 1928 ALLOWED BY VT MEDICAID PER PRIMARY INSURANCE RULES AND OI APPROVAL
119 1929 ITEM PREVIOUSLY PD IN FULL VIA RENTAL/PURCHASE
119 1930 PYMT REDUCED BY AMOUNT PAID FOR RENTAL OF THIS ITEM
16 1931 INVALID PROCEDURE CODE NDC COMBINATION BILLED
16 1932 RESUBMIT WITH MEDICAID WEB PRINTOUT RA
16 1933 RE-ADMISSION DAY SHOULD BE CODED USING SUBSEQUENT HOSPITAL CARE CODES
16 1934 REVIEW DX BILLED. IT DOES NOT APPEAR TO BE CORRECT. RESUBMIT AFTER CORRECTION
45 1935 SECONDARY SURGERY IS MANUALLY PRICED AT 30 PERCENT OF ALLOWED AMOUNT
45 1936 SECONDARY SURGERY IS MANUALLY PRICED AT 40 PERCENT OF ALLOWED AMOUNT
16 1937 REV CDE 199 CAN ONLY BE BILLED IF REV CDE 124 ALSO PRESENT
119 1938 MAX RENTAL/PURCHAS ALREADY EXISTS
251 1939 NOTES DO NOT SUPPORT DUPLICATE BILLING OF TRIPS
16 1940 TAXONOMY IS MISSING OR PROVIDER NUMBER NOT ON FILE
150 1941 1 ADMISSION/OBSERVATION ALLOWED PER 30 DAYS PER SPECIALTY
125 1942 DETAIL CPT/HCPCS CODE NOT VALID
119 1943 MAXIMUM UNITS HAVE ALREADY BEEN PAID FOR THIS SERVICE
16 1944 INCORRECT BILLING OF ADMIN CODE SEE PROVIDER MANUAL FOR CLARIFICATION
125 1945 AH OR AJ MODIFIER REQUIRED FOR THIS PROVIDER TYPE
96 1946 CODES CAN NOT BE BILLED WITHIN SAME CALENDAR MONTH
18 1947 DUPLICATE-A CROSSOVER CLAIM HAS BEEN PAID FOR DOS/PROV
CLAIM ADJUSTMENT REASON CODE CROSS-WALK TO MEDICAID EOB
ADJUSTMENT REASON CODE
MEDICAID EOB
EOB MESSAGE TEXT
169 8000 DETAIL ADDED
150 8001 DETAIL DENIED
59 8002 AMOUNT REDUCED - MULTIPLE SURGERY PROCEDURES
119 8005 1 OFFICE/PREV VISIT PER RECIP.PER DAY,SAME ATT
234 8009 RADIOLOGY CUTBACK - CONTIGUOUS BODY PART
B10 8010 RADIOLOGY CUTBACK CONTIGUOUS BODY PART OUTPATIENT
59 8011 MULTIPLE SURGERY PROCEDURES - PROCEDURE NOT REIMBURSED
59 8012 MULTIPLE SURGERY PROCEDURES - PROCEDURE PAID AT 50 PERCENT
59 8013 MULTIPLE SURGERY PROCEDURES - PROCEDURE PAID AT 40 PERCENT
59 8014 MULTIPLE SURGERY PROCEDURES - PROCEDURE PAID AT 30 PERCENT
234 8020 CLAIM CUTBACK DUE TO ULTRASOUND CONTIGUOUS BODY PART
169 8100 PROCEDURE REPLACES SUBMITTED PROCEDURE - AGE CONFLICT
169 8101 PROCEDURE REPLACES SUBMITTED PROCEDURE - VISIT TYPE CONFLICT
169 8102 PROCEDURE REPLACES SUBMITTED PROCEDURE - REBUNDLE CONFLICT
169 8103 PROCEDURE REPLACES SUBMITTED PROCEDURE - GENDER CONFLICT
6 8104 PROCEDURE REPLACED FOR AGE CONFLICT
97 8105 PROCEDURE IS MUTUALLY EXCLUSIVE TO ANOTHER SUBMITTED PROCEDURE
169 8106 PROCEDURE REPLACED FOR VISIT TYPE CONFLICT
97 8107 PROCEDURE DENIED OR REPLACED - REBUNDLED INTO ANOTHER PROCEDURE
7 8108 PROCEDURE REPLACED FOR GENDER CONFLICT
16 8109 PROCEDURE DOES NOT WARRANT ASSISTANT SURGEON
54 8110 PROCEDURE DOES NOT WARRENT ASSISTANT SURGEON
97 8111 PROCEDURE IS INCIDENTAL TO ANOTHER SUBMITTED PROCEDURE
97 8112 PRE-OPERATIVE SERVICE NOT PAID DURING GLOBAL PERIOD
97 8113 POST-OPERATIVE SERVICE NOT PAID DURING GLOBAL PERIOD
B16 8114 NEW PATIENT PROCEDURE CODES ARE NOT ALLOWED FOR ESTABLISHED PATIENTS
